Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of dysphagia.

Abstract

STUDY OBJECTIVE: The aim of this study was to analyze the role of dysphagia as a model of pharyngeal muscle dysfunction in the time course of nocturnal disordered breathing (NDB) in patients who experienced a first-ever ischemic stroke. DESIGN: Prospective study. PATIENTS AND INTERVENTIONS: Fifty-nine consecutive patients (mean age, 73.2 years; SD, 12.8 years) were studied. Clinical sleep and neurologic data and vascular risk factors were recorded. Two nocturnal studies using a portable autotitration device (AutoSet Portable Plus II system; ResMed; Sydney, NSW, Australia) were performed in both the acute phase (mean duration, 1.23 days; SD, 0.7 day) and the stable phase (mean duration 65.9 days; SD, 12.5 days) of the neurologic event in all patients. RESULTS: The mean total apnea-hypopnea index (AHI) measured with the autotitration device in the acute phase was 34.9 (SD, 25.2) vs 20.1 (SD, 21.7) in the stable phase, both with predominance of obstructive apnea. Patients with dysphagia (n = 30) showed the largest number of obstructive apneic episodes (OAIs) in the acute phase (AHI, 40 episodes; OAI, 30.4 episodes), with a significant reduction in this type of apnea during the stable phase of stroke (AHI, 24.7 episodes; OAI, 17.7 episodes), coinciding with the recovery of pharyngeal muscle function. In contrast, nondysphagic patients (n = 29) showed no significant changes in NDB from the acute to the stable phase of stroke. Logistic regression analysis found dysphagia to be the best independent predictor of AHI reduction of > 50% from baseline (odds ratio, 13.4; 95% confidence interval, 3.3 to 39.6; p = 0.001). CONCLUSION: The present study shows significant improvement in the number obstructive apneic events occurring in the stable phase of a first-ever ischemic stroke in patients with transient pharyngeal muscle alterations secondary to the neurologic lesion.