Optimization of early rehabilitation of patients with ischemic stroke and sleep-disordered breathing

Abstract

Abstract

Introduction. Sleep-disordered breathing (SDB) is detected in 70% of stroke patients and impedes functional rehabilitation; it also increases the length of hospital stay and the risk of stroke recurrence and fatal outcome.

Objective: to study the dynamics of SDB in its correlation with neurological disorders in stroke patients and to develop the approaches to optimization of early rehabilitation.

Materials and methods. A total of 78 patients with acute ischemic stroke were examined. SDB was verified by cardiorespiratory monitoring; the neurological deficit was assessed using the NIHSS and mRS scales. Examination was carried out upon admission (days 2–5 post stroke) and again after 3 weeks. The effect of SDB correction on effectiveness of neurological recovery was studied using positional therapy (position elevated by 30о) in combination with oxygen therapy (insufflation of O2 with the saturation level maintained no less than 95% under control of a digital sensor).

Results. Upon admission, SDB was revealed in 88% of patients; moderate and severe disorders being predominant (the apnea/hypopnea index (AHI) ≥15 h-1), most frequently presenting as obstructive apnea. In patients with AHI < 15 h-1, the positive dynamics of neurological disorders (p<0.04) were observed along with stable SDB parameters. Neurological improvement (р<0.05) was observed in patients with AHI ≥ 15 h-1, which was associated with decreased severity of SDB. A direct correlation between the severity of neurological disorders and AHI after 3 weeks was revealed: RNIHSS/AHI = 0.45 (р=0.003), RmRS/AHI = 0.44 (р=0.004). Patients with AHI ≥ 15 h-1 were distributed into 2 groups: group A (without corrective interventions) and group B (the use of positional and oxygen therapy during the night sleep during 7 days). A positive effect of the course of corrective therapy on restoration of neurological functions, along with a decrease in AHI, was revealed.

Conclusions. SDB is a frequent and persistent disorder in patients with ischemic stroke. Early detection and correction of SDB should be regarded as an important component of post-stroke rehabilitation.

About the authors

Gleb M. Lutokhin

Research Center of Neurology, Moscow

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

Ludmila A. Geraskina

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

Andrey V. Fonyakin

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

Marina Yu. Maksimova

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

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