Are stroke cases affected by sleep disordered breathings all the same?

Area of Science:

• Neurology
• Sleep Medicine
• Cardiovascular Research

Background:

• Sleep disordered breathing (SDB) negatively impacts stroke patient prognosis.
• Continuous positive airway pressure (CPAP) is a potential treatment for obstructive sleep apnoea (OSA) post-stroke.
• Patient adherence to CPAP varies, necessitating identification of optimal candidates.

Purpose of the Study:

• To propose a classification system for stroke patients with SDB.
• To identify subgroups most likely to benefit from CPAP treatment.
• To investigate the impact of stroke on sleep microstructure.

Main Methods:

• Classification of SDB in stroke patients into four subgroups based on breathing termination mechanisms and stroke effects.
• Analysis of polysomnography (PSG) tracings, including sleep microstructure.
• Systematic review of stroke patient PSG data.

Main Results:

• Stroke patients with SDB can be categorized into four distinct subgroups.
• Subgroup 1: Upper airway obstruction (anatomical/functional).
• Subgroup 2: Alternating OSA and central sleep apnoea (CSA) due to altered loop gain.
• Subgroup 3: Impaired sleep microstructure (CAP) from ischemic damage.
• Subgroup 4: CSA as a direct result of stroke affecting respiratory drive.

Conclusions:

• A novel classification aids in identifying stroke patients who will best respond to CPAP.
• Understanding stroke's impact on sleep microstructure is crucial.
• Systematic analysis of sleep microstructure in stroke patients is warranted.