Prevalence, effect on functional outcome, and treatment of sleep-disordered breathing in patients with subacute stroke

Abstract

Study Objectives: We aimed to elucidate the prevalence of sleep-disordered breathing (SDB), effect of SDB severity on the functional outcome, and feasibility of continuous positive airway pressure (CPAP) therapy in patients with subacute stroke. Methods: We recruited 433 consecutive patients (mean age: 66.5 years, 271 men) admitted to our rehabilitation wards for subacute stroke (8 to 90 days after onset) from August 2011–November 2013, who had undergone at least one successful sleep study within 4 weeks after admission to the wards. We investigated the prevalence of SDB, defined as a respiratory event index (REI) ≥ 5 events/h; the relationship between SDB severity and the functional outcome at discharge; and the number of patients receiving and adhering to CPAP therapy. Results: REIs ≥ 5 and ≥ 15 events/h were observed for 87.3% (n = 378) and 46.4% (n = 201) of patients, respectively. The Functional Independence Measure score at discharge was significantly lower for patients with REI ≥ 15 events/h than for those with REI < 15 events/h. However, REI was not an independent factor for functional outcome after adjustment for potential confounders, irrespective of stroke types. CPAP therapy was administered to 41 patients (9.5%). During the mean follow-up period of 21.6 months, 20 patients (48.8%) dropped out from the CPAP therapy. Among the 23 patients who continued CPAP therapy until discharge, 17 (74%) continued its use throughout the follow-up period or discontinued therapy because of improvement. Conclusions: SDB prevalence was high in patients with subacute stroke at admission. However, SDB severity was not significantly related to functional outcome at discharge. Although the overall adherence was not good, relatively good adherence to CPAP therapy after discharge was observed when CPAP was successfully introduced during hospitalization.