Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke

The prevalence of sleep-disordered breathing after stroke has been reported to be between 32% and 71%. However, the first 24-hour period, when upper airway obstruction may have a critical effect on the cerebral circulation because of hemodynamic fluctuations and repetitive hypoxia, has not been studied. Furthermore, data on prediction of upper airway obstruction after stroke are limited. This study sought to assess the prevalence of upper airway obstruction in the first 24 hours of stroke and to ascertain whether its occurrence could be predicted.

One hundred twenty patients with acute stroke underwent a respiratory variable-only sleep study, started within 24 hours of onset of neurological symptoms. Sleep history and stroke characteristics were recorded on admission.

We found that 79%, 61%, and 45% of the patients had a respiratory disturbance index greater than 5, 10, and 15 events per hour, respectively. Patients had a significantly higher respiratory disturbance index when nursed in the supine (29 events per hour), supine left (29 events per hour), and supine right (24 events per hour) positions than in any other position (P<0.0001). On logistic regression analysis, BMI (P=0.025), neck circumference (P=0.026), and limb weakness (P=0.025) independently predicted the occurrence of upper airway obstruction in the first 24 hours after acute stroke.

Upper airway obstruction is common in the first 24 hours after stroke, especially if patients are nursed in the supine position, and typical obstructive sleep apnea risk factors (body mass index and neck circumference) appear to be the best predictors of its occurrence. Stroke characteristics (severity, clinical subtype, and clinically assessed pharyngeal function) are not independently associated with upper airway obstruction after stroke.