Subjective and objective features of sleep disorders in patients with acute ischemic or haemorrhagic stroke: It is not only sleep apnoea which is important.
BACKGROUND
More than half of stroke patients present with a sleep-related breathing disorder including both central and obstructive forms of sleep apnoea. A cerebral infarction in different brain areas can disrupt sleep regulating pathways and cause insomnia, hypersomnia, circadian rhythm disturbances and other sleep disorders. Therefore, there is a need of objective data about various sleep disorders arising after ischemic or haemorrhagic stroke in order to implement practical recommendations how to suspect, diagnose and treat these conditions. Our medical hypothesis is that non-breathing sleep disorders are common among patients with acute ischemic or haemorrhagic stroke.


OBJECTIVE
To investigate the subjective and objective sleep parameters in the patients with an acute ischemic or haemorrhagic stroke.


METHODS
In the acute period (from 3 to 10 days after the first symptoms) of stroke all the patients completed questionnaires about sleep complaints and symptoms experienced before and after stroke, Epworth Sleepiness Scale (ESS), National Institute of Health Stroke Scale, Hospital Anxiety and Depression Scale and Modified Rankin Scale. Patients were included for further polysomnography (PSG) and sleep electroencephalography according to these criteria: (1) patients expressing severe sleep related complaints and/or symptoms that are new or have exacerbated after the stroke; and/or (2) patients having the ESS score equal or >10.


RESULTS
66 patients were examined in the acute period of stroke. 33 (50%) patients had at least one or more new or exacerbated sleep complaints and/or symptoms, mostly related to obstructive sleep apnoea (OSA) and insomnia. Finally, 13 (19.7% of the whole sample) patients were selected for performing PSG. 12 of 13 patients were diagnosed with sleep disorder: 1 patient got the diagnosis of mild OSA, 1 - central sleep apnoea (CSA), 2 - combination of OSA and CSA, 1 - combination of mild OSA, periodic limb movement disorder (PLMD) and REM sleep behaviour disorder (RBD), 1 - combination of mild OSA and PLMD, 3 - combination of PLMD and insomnia, 3 - insomnia. There were no significant relations between type, location or treatment of stroke and various PSG measures, as well as type of a diagnosed sleep disorder.


CONCLUSIONS
Half of our acute stroke patients had at least one or more new or exacerbated sleep complaints and/or symptoms, mainly related to OSA or insomnia. In the selected PSG group almost all patients were diagnosed with a sleep disorder, half of them having non-breathing sleep disorder, such as PLMD, RBD and insomnia.
['Pajediene|Evelina|E|', 'Pajeda|Adomas|A|', 'Urnieziute|Gintare|G|', 'Paulekas|Erlandas|E|', 'Liesiene|Vanda|V|', 'Bileviciute-Ljungar|Indre|I|', 'Jurkeviciene|Giedre|G|', 'Rastenyte|Daiva|D|', 'Petrikonis|Kestutis|K|']
D000328:Adult D000368:Aged D005260:Female D000083302:Hemorrhagic Stroke D006801:Humans D000083242:Ischemic Stroke D008297:Male D008875:Middle Aged D009068:Movement D017286:Polysomnography D011446:Prospective Studies D012189:Retrospective Studies D012720:Severity of Illness Index D012891:Sleep Apnea Syndromes D012893:Sleep Wake Disorders D012895:Sleep, REM D020521:Stroke D011795:Surveys and Questionnaires
Sleep Stroke Sleep apnoea Periodic limb movement disorder REM sleep behaviour disorder