SDB and stroke

The majority of patients who have experienced a stroke and transient ischemic attack (TIA) also have sleep-disordered breathing (SDB),¹  which is sometimes undiagnosed. As stroke patients with SDB also have worse functional outcomes², you should consider screening for SDB³ when investigating the stroke.

Stroke has the potential to cause SDB, by either affecting:

• central mechanisms resulting in central sleep apnoea, or
• muscle tone resulting in obstructive sleep apnoea.

Can SDB predispose people to strokes?

People with SDB may be predisposed to stroke through a number of symptoms they experience.

In particular:

• Repetitive drops in nocturnal blood oxygen levels caused by SDB can result in intermittent hypoxia which has been shown to be associated with systemic inflammation.⁴
• Sleep fragmentation from SDB results in hypersympathetic activity.⁵

What is the impact of SDB on post-stroke rehabilitation?

Patients with both SDB and stroke usually show poor compliance with post-stroke rehabilitation programs. This is mainly due to the combination of:

• the deficits caused by the stroke; and
• the symptoms of SDB (such as excessive daytime sleepiness, fatigue, and impaired cognitive functioning).

How do I recognise and diagnose SDB in stroke survivors?

Recognising SDB in stroke survivors is often challenging because the symptoms associated with SDB are often attributed to stroke. A complete sleep history from family members can help you determine whether SDB was present prior to the stroke or developed after the stroke.