Case Report

An Overnight Rhythmic Sleep-Wake Pattern in Stroke and Obstructive Sleep Apnea: A Case Report and Literature Review

Abstract

Background and Objective: Obstructive sleep apnea (OSA) is a common sleep breathing disorder and a comorbid condition in patients with stroke. The prevalence of sleep disorders as a stroke consequence is high. Being independent of vascular risk factors, OSA is associated with increased risk of ischemic stroke. Here, we report a patient with OSA and stroke.
Case Report: This case report presents a patient with a history of stroke and hemiparesis who underwent polysomnog-raphy (PSG) for evaluating OSA because of snoring, witnessed apnea, and excessive daytime sleepiness (EDS). Then the subject underwent continuous positive airway pressure (CPAP) titration for treating OSA. In first night of PSG, there was a repetitive cyclic pattern of sleep and arousals. After CPAP titration study and with CPAP pressure of 15 cmH2o, OSA and rhythmic changes of electroencephalography (EEG) were resolved.
Conclusion: OSA as a risk factor for stroke can be associated with PSG cyclic wake-sleep pattern in these patients, and this pattern can be resolved by CPAP therapy.

1. Jehan S, Farag M, Zizi F, et al. Obstructive sleep apnea and stroke. Sleep Med Disord 2018; 2: 120-5.
2. Stahl SM, Yaggi HK, Taylor S, et al. Infarct loca-tion and sleep apnea: Evaluating the potential associa-tion in acute ischemic stroke. Sleep Med 2015; 16: 1198-203.
3. Buchanan P, Grunstein R. Positive airway pressure treatment for obstructive sleep apnea-hypopnea syn-drome. In: Kryger MH, Roth T, Dement WC, Editors. Principles and practice of sleep medicine. Philadelphia, PA: Saunders/Elsevier; 2011. p. 1233-49.
4. Bravata DM, Concato J, Fried Tea. Continuous pos-itive airway pressure: Evaluation of a novel therapy for patients with acute ischemic stroke. Sleep 2011; 34: 1271-7.
5. Disler P, Hansford A, Skelton J, et al. Diagnosis and treatment of obstructive sleep apnea in a stroke rehabil-itation unit: A feasibility study. Am J Phys Med Re-habil 2002; 81: 622-5.
6. Wallace DM, Ramos AR, Rundek T. Sleep disor-ders and stroke. Int J Stroke 2012; 7: 231-42.
7. Stevens D, Martins RT, Mukherjee S, et al. Post-stroke sleep-disordered breathing-pathophysiology and therapy options. Front Surg 2018; 5: 9.
8. Simms T, Brijbassi M, Montemurro LT, et al. Dif-ferential timing of arousals in obstructive and central sleep apnea in patients with heart failure. J Clin Sleep Med 2013; 9: 773-9.
9. Hermann DM, Bassetti CL. Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology 2016; 87: 1407-16.
10. Gottselig JM, Bassetti CL, Achermann P. Power and coherence of sleep spindle frequency activity fol-lowing hemispheric stroke. Brain 2002; 125: 373-83.
11. American Academy of Sleep Medicine. The inter-national classification of sleep disorders: Diagnostic & Coding Manual. Darien, IL: American Academy of Sleep Medicine; 2005.
12. Bassetti CL. Sleep and stroke. Semin Neurol 2005; 25: 19-32.
13. Lim AS, Yu L, Schneider JA, et al. Sleep fragmen-tation, cerebral arteriolosclerosis, and brain infarct pa-thology in community-dwelling older people. Stroke 2016; 47: 516-8.
14. Korkmaz S, Bilecenoglu NT, Aksu M, et al. Cyclic alternating pattern in obstructive sleep apnea patients with versus without excessive sleepiness. Sleep Disord 2018; 2018: 8713409.
15. Mohsenin V, Valor R. Sleep apnea in patients with hemispheric stroke. Arch Phys Med Rehabil 1995; 76: 71-6.
16. Gupta A, Shukla G, Afsar M, et al. Role of posi-tive airway pressure therapy for obstructive sleep ap-nea in patients with stroke: A randomized controlled trial. J Clin Sleep Med 2018; 14: 511-21.
Files
IssueVol 5 No 1 (2020): Winter QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/jss.v5i1.4571
Keywords
Obstructive sleep apnea; Stroke; Continuous positive airway pressure; Arousal

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Amirifard H, Najafi A, Rahimi-Golkhandan A, Shojaie M. An Overnight Rhythmic Sleep-Wake Pattern in Stroke and Obstructive Sleep Apnea: A Case Report and Literature Review. J Sleep Sci. 2020;5(1):35-38.