J Sleep Med.  2019 Dec;16(2):81-87. 10.13078/jsm.190034.

Cheyne-Stokes Respiration and the Outcome of Acute Ischemic Stroke

Affiliations
  • 1Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea.
  • 2School of Medicine, Kangwon National University, Chuncheon, Korea.
  • 3Department of Neurology, School of Medicine, Kangwon National University, Chuncheon, Korea. leeseoyoung@kangwon.ac.kr
  • 4Gangwon Comprehensive Stroke Center, Kangwon National University Hospital, Chuncheon, Korea.

Abstract


OBJECTIVES
Cheyne-Stokes respiration (CSR) is frequently observed in acute stroke patients. In case of heart failure, CSR has been reported to be a poor prognostic factor. However, whether CSR has negative predictive value in stroke is not established yet. We aimed to investigate the relation between the presence of CSR and the outcome of acute stroke.
METHODS
We investigated the patients who were admitted with acute ischemic stroke and received sleep apnea test. We collected data on demographics, risk factors, etiologic subtypes and the parameters associated with respiratory events in sleep apnea test. Primary outcome was the occurrence of early neurologic deterioration (END) within 3 weeks. Secondary outcome included the modified Rankin Scale (mRS) score at 3 months after stroke. We assessed the risk of poor outcome associated with CSR using multivariate logistic regression.
RESULTS
Among 182 patients, 35 (19.2%) showed CSR in sleep apnea test. The presence of CSR in acute stroke was not associated with END, but associated with increased risk of 3 or higher mRS score at 3 months (odds ratio, 3.02; 95% confidence interval, 1.39 to 6.55) in univariate analysis. The association was still significant in large artery atherosclerosis group in stratified analysis. However, this association was insignificant in multivariate analysis which revealed that poor outcome at 3 months was associated with obstructive sleep apnea, as well as territory of internal carotid artery or basilar artery, initial National Institutes of Health Stroke Scale, and history of previous stroke.
CONCLUSIONS
The presence of CSR was associated with poor functional outcome after acute stroke. However, large scaled study is needed to confirm the role of CSR as an independent prognostic factor of stroke.

Keyword

Cheyne-Stokes respiration; Stroke; Prognosis

MeSH Terms

Arteries
Atherosclerosis
Basilar Artery
Carotid Artery, Internal
Cheyne-Stokes Respiration*
Demography
Heart Failure
Humans
Logistic Models
Multivariate Analysis
National Institutes of Health (U.S.)
Prognosis
Risk Factors
Sleep Apnea Syndromes
Sleep Apnea, Obstructive
Stroke*
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