If You’ve Had A Stroke
According to the Mayo Clinic, most patients who have strokes develop sleep apnea even if they didn’t have it prior to the stroke. If you have OSA following a stroke, you should be concerned, as this is associated with less complete recovery, worsening of stroke symptoms, and a higher chance of death.
What’s more: Using CPAP to treat sleep apnea may become problematic for victims of stroke, as functional damage caused by stroke can make it difficult to use. However, alternative therapies can be helpful in treating OSA for some patients.
It’s easy to check your blood pressure. You can do it at home using a portable device, or you can go to the store and use one of their machines. You can even go to the fire station and have the medics there take a look. Remember, high blood pressure is a silent killer. You may never notice its symptoms.
If yours is elevated , you need to contact your doctor immediately. Treatments for hypertension are readily available, easy to take, and affordable. This simple approach can help you avoid major health problems, including stroke.
In addition, if you suspect you have a sleep-breathing disorder like sleep apnea, please have it checked out. Treating your OSA may also improve your hypertension and could even save you from having a stroke.
American Academy of Sleep MedicineAmerican Heart AssociationJournal of Clinical Sleep MedicineMayo Clinic
Sleep Apnea May Alter Cerebral Hemodynamics
Sleep apnea may negatively influence the clinical course in the acute phase of ischemic stroke. More specifically, up to an 8-fold increased risk for early worsening of neurological symptoms within 72 hours from stroke onset has been described.11 In patients with sleep apnea, cerebral autoregulation is impaired as demonstrated by transcranial Doppler studies,12 putting further brain tissues at risk of ischemic injury. In the most severe case, this may lead to depletion of the collateral blood flow when vessels in the non-ischemic area dilate more, leading to blood flow diversion from the ischemic area to the non-ischemic areas. This process is mediated by vasomotor reactivity in response to simple stimuli, such as arterial carbon dioxide increase with hypoventilation. Apnea may further worsen hypoperfusion in the ischemic brain area. This “cerebral blood flow steal – phenomenon” was demonstrated by transcranial Doppler in real time. When it lead to early neurological worsening it was termed the reversed Robin Hood syndrome as it serves “to rob the poor to feed the rich.”13 When found during the initial hospitalization for an ischemic stroke, this syndrome leads to a 4-fold increase in stroke recurrence within the same arterial territory.14
Trouble Sleeping After A Stroke
Stroke patients have long complained about trouble sleeping. Now, a shows that this might actually reduce stroke patients ability to recover and relearn key skills. On top of that, long-term insomnia can lead to depression.
Using a polysomnogram test, which measures the brains sleeping patterns, researchers found that it took stroke patients longer to fall asleep and that they had poorer sleep efficiencya ratio of the time spent asleep compared to the time spent in bedthan those who had not experienced a stroke. The Scientific Reports study also showed that stroke patients were less likely to nap during the day to make up for lost sleep at night. The lack of sleep put stroke patients at a higher risk for another stroke, falls, recovery delays, and poorer overall health.
How To Treat Sleep Problems
Treatments for insomnia may include prescription sedatives or changes in your bedroom or nighttime activities. Continuous positive airway pressure or CPAP is one of the most common and effective treatments for sleep-related breathing disorders like sleep apnea. A CPAP machine delivers short bursts of compressed air to prevent airway obstruction and help you get a better nights sleep. There are other ways to control sleep-related breathing disorders. A special mouthpiece can be made to help minimize your symptoms. Mouthpieces prevent teeth-clenching and prevent the tongue from interfering with breathing. In some cases, upper airway surgery can result in a wider airway and relieve sleep problems. Some medications may also help.
Sleep-wake cycle disorders can be treated in a variety of ways. Talk with your healthcare team. Bright light therapy may help. The treatment is typically administered in the morning and may last about 30 minutes.
Melatonin is a hormone taken at night. It acts like a sedative and can help induce sleep. Sleep-wake cycle disorders are not usually permanent.
Stroke Topography And Sdb
Evidence suggests that damage to specific brain structures can affect breathing patterns in both wakefulness and sleep. Several studies have failed to identify a relationship between stroke topography and type or severity of SDB . Other studies have found an association between both SDB severity and type with specific topographies of stroke. For example, one study suggests that the frequency of SDB is higher after brainstem stroke . A few observations suggest that CSA may be related to specific lesions affecting the central autonomic network . Several case reports have suggested that stroke location may impact the type or severity of SDB. Faludi et al. describe a case of stroke in the bilateral paramedian mesencephalon and thalamus with evolution of SDB from CSA to OSA. Focal ischemic lesions in the medulla oblongata have been shown to cause CSA with a necessity of mechanical ventilation and slow recovery. Planjar-Prvan et al. present two cases of fatal CSA in patients with infarcts in the medulla oblongata at the level of the solitary tract nuclei. On the other hand, De Paolis et al. describe a shift of a preexisting OSA into a severe CSA after an ischemic stroke located in the posterior limb of the left internal capsule and corona radiata.
Sleep Apnoea And Autonomic Nervous System
Understanding the effects of sleep apnoea on autonomic nervous system is important for better understanding of the subsequent sections. The body’s biological clocksuprachiasmatic nucleus has autonomous rhythmicity in its neuronal activity The autonomic body functions modulated by SCN include sympatheticparasympathetic balance, hepatic glucose production and insulin sensitivity.
Use of CPAP improves sympatheticparasympathetic balance in patients with moderate and severe sleep apnoea and improves heart rate variability. Increase in catecholamines has been found in urine and plasma in patients with OSA which can be lowered with therapies.
In summary, patients with untreated sleep apnoea tend to have a heightened sympathetic activity and autonomic dysregulation which can benefit with management of OSA with either CPAP or tracheostomy.
Avoid Alcohol And Sleeping Pills
If you have trouble sleeping, try a cup of decaffeinated herbal tea or juice instead of unwinding with a glass of wine. Alcohol and certain medications can make throat muscles relax more than normal. As a result, airways can get blocked. Alcohol and medications can also make it harder for your brain to “wake up” and register a lack of oxygen in the body. This can cause longer and more serious pauses in breathing. If you find it hard to fall asleep, try reading a book or taking a warm bath.
Sleep Apnoea In Acute Stroke
Epidemiology of sleep apnoea in acute stroke
Respiratory changes are seen acutely after stroke and can be divided into sleepwake cycle and SDB. The changes may vary with the location of the stroke. As mentioned in an earlier section, OSA is part of SDB which includes central sleep apnoea. About 5070% of patients with stroke have SDB as defined by AHI10/hour with OSA being the most common pathology. Some studies indicate that during the first 5days poststroke central sleep apnoea predominates.
The frequency of OSA itself has been reported to be between 38% when measured as AHI>20/hour to 72% when measured as AHI>5/hour in a meta-analysis performed by Johnson and Johnson only 7% of SDB was central apnoea. Males had a higher percentage of SDB than females . Patients with recurrent strokes had higher percentage of SDB than patients with first stroke . A small study involving patients in an acute stroke rehabilitation unit demonstrated AHI >10 in 91% of the studied population with a mean AHI of 32/hour. Worsening of OSA may also be found after acute stroke due to impairment of respiratory muscle coordination. In some studies, presence of dysphagia was found to predict the development of OSA in patients with acute stroke, while another suggests that presence of prestroke leucoencephalopathy predicts a more severe OSA. BMI and neck circumference have also been found to predict the presence of OSA in poststroke patients.
Screening patients with acute stroke for sleep apnoea
Can Sleep Apnea Cause A Stroke
If youre concerned about sleep apnea stroke risk, its important to understand how these two conditions are closely connected. Both conditions interact in unique ways in the brain, leading them to affect one another in various ways.
A stroke is a disease that has a direct impact on the arteries and brain. In particular, a stroke is known to influence the arteries found inside the brain as well as the arteries that lead to the brain. When a blood vessel that sends vital nutrients and oxygen to the brain is ruptured, a stroke occurs. A stroke can also take place when a blood clot blocks the blood vessel, preventing it from supplying the brain with sufficient oxygen and nutrients.
When the blood vessel ruptures, it is known as a hemorrhagic stroke. An ischemic stroke, on the other hand, refers to a stroke characterized by a blood clot blocking the blood vessel.
Sleep apnea plays a direct role in both types of stroke. When your breathing is interrupted during sleep, your blood becomes deprived of the vital oxygen it needs. As a result, your brain doesnt receive the oxygen that is required for numerous daily functions.
If your sleep apnea becomes serious enough, it may increase your risk of stroke. Prolonged sleep apnea can lead to either a hemorrhagic stroke or an ischemic stroke, depending on the form of sleep apnea and how it affects your brain.
Sleep Apnea Linked To Silent Strokes
Breathing Pauses During Sleep Tied to Brain Lesions
Feb. 1, 2012 — A common sleep disorder is associated with an increased risk of symptomless but serious strokes called silent strokes, German researchers report.
Sleep apnea, a condition marked by periodic interruptions in breathing during , has been linked to an increased risk of strokes. But there hasn’t been much research exploring the relationship between sleep apnea and silent strokes, says researcher Jessica Kepplinger, MD, of Dresden University Center at the University of Technology in Dresden, Germany.
So, Kepplinger and colleagues studied 56 men and women, aged 44 to 75 years, whod had a or mini- known as a transient ischemic attack. All were given a screening tool that picks up changes in breathing during .
Ninety-one percent periodically stopped breathing while they slept.
Then the men and women underwent imaging scans. Just over half had little areas of tissue death in the that had occurred in the past without a history of corresponding stroke symptoms — evidence, Kepplinger tells WebMD, of silent stroke.
The more times a person stopped breathing during the night, the greater the likelihood of silent stroke, she says.
There was no comparison group, so researchers don’t know how many people of the same ages and health status who don’t have sleep apnea have had silent strokes.
Link Between Breathing And Stroke
MRI imaging studies suggest about 20% to 25% of people over age 60 have had a silent stroke, according to Harvard Medical School neurologist Steven Greenberg, MD, PhD. They have been linked to memory loss in some people, he says.
The study offers “good evidence linking” sleep apnea to silent stroke, Greenberg tells WebMD. But this is just an observation of an association between the two that needs further study, he says.
Greenberg moderated a news briefing to discuss the findings at the American Stroke Association’s International Stroke Conference.
The study is small and preliminary. But it poses a number of questions that deserve further research, says Harvard neurologist Lee Schwamm, MD.
“I think what we can say is that breathing problems are more common in stroke patients than suspected,” he tells WebMD.
“But is abnormal breathing during sleep a long-term problem in these patients? Or will it go away? And is abnormal breathing a risk factor that leads to stroke? Or is it a consequence of stroke?” Schwamm asks.
Kepplinger plans further study. In the meantime, she says, all stroke patients should be screened for sleep apnea.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.
What Is Sleep Apnea
Sleep apnea is a serious sleep disorder that happens when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night.
If its not treated, sleep apnea can cause a number of health problems, including , , , heart failure, and heart attacks. Untreated sleep apnea can also be responsible for job impairment, work-related accidents and motor vehicle crashes, as well as underachievement in school in children and adolescents.
There are two types of sleep apnea, obstructive and central:
- Obstructive sleep apnea is the more common of the two. Obstructive sleep apnea occurs as repetitive episodes of complete or partial upper airway blockage during sleep. During an apneic episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk. These episodes can interfere with sound sleep, reduce the flow of oxygen to vital organs, and cause heart rhythm irregularities.
- In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is related to the function of the central nervous system.
Why Are Sleep Apnea And Stroke Risks Related
Nearly 70% of first-time ischemic stroke patients have sleep apnea, showing that this can be a dangerous duo.
Dr. Melissa Lipford, a neurologist at the Center for Sleep Medicine at Mayo Clinic in Minnesota, explains one reason why the risk of stroke increases in people with sleep apnea:
During an apneic episode, the body asserts an amazing amount of effort to try to open the airway and get a breath in. Unfortunately, this effort frequently fails to supply the brain with the oxygen it needs to keep the entire body and all its systems working smoothly as you sleep.
In a healthy sleeper, the inhalation of oxygen is accompanied by the exhalation of carbon dioxide. Without this exchange of gases, carbon dioxide builds to unhealthy levels in the bloodstream. Excess carbon dioxide leads to excessive blood flow in the brain, leading to high blood pressure. High blood pressure increases the risk of stroke.
There is also some evidence that inflammation in the brain due to sleep apnea may contribute to the increased risk of stroke. The complicating factor is the increased inflammation is also causing more incidence of cardiovascular complications due to sleep apnea. Its challenging for researchers to know if the inflammation comes from the cardiovascular complications and then leads to stroke, or if the inflammation is present only in people with stroke.
Sleep Apnea Is A Risk Factor For Acute Ischemic Stroke
Two prospective cohort studies revealed a 2- to 4.5- fold independent risk for a first-ever ischemic stroke in patients with sleep apnea compared to those without,4-5 suggesting that sleep apnea constitutes a pre-existing condition rather than a consequence of acute ischemic brain damage. Moreover, the cumulative risk of suffering a recurrent ischemic stroke may grow notably in stroke victims who have co-existing sleep apnea.6,7 Yet it still remains a matter of debate whether the deleterious effects of sleep apnea are independent of other comorbidities often existing in those who have suffered a stroke, such as hypertension, atherosclerotic disease or atrial fibrillation.
Stroke And Sleep Apnea
How have you been sleeping lately? Do you feel well rested when you wake up in the morning? If not, and you are a survivor of stroke, one possible cause could be sleep apnea, which is a very common condition in both the general population and especially in survivors of stroke.
Keeping your brain as healthy as possible after youve had a stroke is important and obtaining quality sleep plays a huge role in maintaining brain health. Unfortunately, untreated sleep apnea significantly lowers your quality of sleep, increases the risk of having a stroke. For those who have already had a stroke, the risk of a recurrent stroke is even greater.
This video covers some general information about sleep apnea, including risk factors, symptoms, and common treatments. If you have any concerns after viewing this information, please reach out to your doctor.
What is Sleep Apnea?
Sleep apnea is a condition that results in abnormal breathing because of changes in a persons airflow that occurs while they are asleep, resulting in multiple extended pauses in breath when they sleep. These temporary breathing lapses cause lower-quality sleep and affect the bodys supply of oxygen, leading to potentially serious health consequences.
Screening for Sleep Apnea
What to Expect
What Are The Effects Of Sleep Apnea
If left untreated, sleep apnea can result in a number of health problems including hypertension, stroke, arrhythmias, cardiomyopathy , heart failure, diabetes, obesity and heart attacks.
Its likely that sleep apnea can cause arrhythmias and heart failure because if you have sleep apnea, you tend to have higher blood pressure. In fact, sleep apnea occurs in about 50% of people with heart failure or atrial fibrillation.
This is because sleep apnea can cause:
- Repeated episodes of oxygen lowering .
- Changes in carbon dioxide levels.
- Direct effects on the heart due to pressure changes within the chest.
- Increased levels of markers of inflammation.
With the high prevalence of sleep apnea in cardiac arrhythmias and heart failure , experts recommend that you dont delay in seeking the advice of your physician.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2020.
How Is Sleep Apnea Diagnosed
If your doctor determines that you have symptoms suggestive of sleep apnea, you may be asked to have a sleep evaluation with a sleep specialist or may order an overnight sleep study to objectively evaluate for sleep apnea.
- Testing includes an overnight sleep study called a polysomnogram . A PSG is performed in a sleep laboratory under the direct supervision of a trained technologist. During the test, a variety of body functions, such as the electrical activity of the brain, eye movements, muscle activity, heart rate, breathing patterns, air flow, and blood oxygen levels are recorded at night during sleep. After the study is completed, the number of times breathing is impaired during sleep is tallied and the severity of the sleep apnea is graded.
- For adults, a Home Sleep Test can sometimes be performed instead. This is a modified type of sleep study that can be done in the comfort of home. It records fewer body functions than PSG, including airflow, breathing effort, blood oxygen levels and snoring to confirm a diagnosis of moderate to severe obstructive sleep apnea.
An HST is not appropriate to be used as a screening tool for patients without symptoms. Its not used for patients with significant medical problems . Its also not used for patients who have other sleep disorders in addition to the suspected obstructive sleep apnea.
Sleep Apnea May Increase Your Risk For Stroke
Did you know sleep apnea can increase your risk for a stroke? S.A. is a common condition, but many people arent aware of the health risks associated with untreated S.A. One of these risks include a higher risk for stroke. Strokes are the second leading cause of death in the U.S., second only to heart disease. Strokes are also a leading cause of disability for adults in the U.S. Therefore, its important to understand your risks for stroke to help you take care of your health.
The Most Extensive Network Of Sleep Apnea Solutions In Bc
When it comes to your ability to breathe as you sleep, nothing beats the commitment of the team at CanSleep Services. With a presence in Surrey, Burnaby, Delta, New Westminster, Coquitlam, Penticton and Victoria, BC, our sleep apnea clinics provide you with integrated snoring and sleep apnea treatments to help improve your sleep quality. Rather than suffer the potentially life-threatening consequences of sleep apnea, tackle the problem head-on and schedule a free consultation by calling us at 1.844.SLEEP40
Stick To A Regular Sleep Schedule
Going to bed and waking up at roughly the same times every day helps you to get the right kind of sleep. You need to experience the full cycle of deep- and lighter-stage sleep to feel well rested. A regular sleeping schedule also prevents you from getting overtired, which can make sleep apnea symptoms worse.
Sleep Apnea: Forgetting To Breathe
Sleep apnea is a sleep-related breathing disorder that is most common in middle age. Often, but not always, people with sleep apnea are overweight.
Obstructive sleep apnea is the most common type of sleep apnea. The airway is being closed off by soft tissue, causing loud snoring.
Daytime symptoms of OSA include drowsiness, headaches, short attention span, and memory loss.
Central sleep apnea is less common but just as dangerous. Signals between the brain and the breathing mechanism misfire as a person sleeps, causing them to actually stop breathing until the brain becomes aware of carbon dioxide building up in the bloodstream, and tells the person to wake up and breathe.
The Pathophysiologic Mechanism By Which Sleep Apnea Contributes To Cerebrovascular Complications Is Not Fully Understood
A variety of mechanisms such as inflammatory processes, endothelial malfunction, enhanced activity of thrombocytes and coagulation factors leading to hypercoagulable state, and progression of atherosclerosis may trigger atherothrombotic and embolic strokes.2,8 The latter mechanism is supported by a recent observation that the intima media thickness in the carotid arteries, a marker for general atherosclerotic burden, seems much more accentuated in patients with sleep apnea than in those without.9 Cardiac arrhythmias may be of particular interest, as approximately 50% of patients with atrial fibrillation presenting for cardioversion have obstructive sleep apnea as compared with 30% in the general cardiology population.8 Also, intrathoracic pressure changes in patients with obstructive sleep apnea may boost the risk for paradoxical embolism in those who have a co-existing patent foramen ovale, justifying further diagnostic evaluation for sleep apnea. In addition, a wide spectrum of further cardiovascular abnormalities affecting systemic hemodynamics has been reported in patients with sleep apnea.8 However, the variety of proposed underlying mechanisms might explain why no particular stroke etiology has been linked to sleep apnea so far.1,2 Of note, the assumption that abnormal cardiovascular responses to nocturnal apnea episodes contribute to sleep-related ischemic strokes has not been fully supported by various studies with divergent results.
What Are The Symptoms Of A Stroke
- Sudden numbness or weakness in the face and/or extremities, especially favoring one side of the body
- Sudden problems with speech and general confusion
- Sudden vision problems in one or both eyes
- Sudden issues with dizziness, balance, coordination, and/or walking
- Sudden severe headache with no obvious cause
The National Stroke Foundation offers this easy-to-memorize approach for addressing concerns if you suspect someone is having a stroke:
“Remember to think FAST:
- FACE: Ask the person to smile. Does one side of the face droop?
- ARMS: Ask the person to raise both arms. Does one arm drift downward?
- SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
- TIME: If you observe any of these signs, call 9-1-1 immediately.”
Researchers Find Those With Brain Stem Injury Are More Likely To Develop The Condition
WEDNESDAY, Feb. 12, 2014 — Stroke patients who have damage to their brain stem are more likely to have sleep apnea than those with damage in other parts of their brain, Michigan researchers report.
Their study included 355 people in Texas, average age 65, who suffered an ischemic stroke, which is caused by blocked blood flow in the brain. Fifty-five percent of the patients were men, 59 percent were Hispanic, 35 percent were white, 4 percent were black and 1 percent were Native American.
The researchers used CT and MRI brain scans to assess brain damage in the patients, who were assessed for sleep apnea about 13 days after their stroke. Of the 11 percent who had damage to the brain stem, 84 percent had sleep apnea. By comparison, only 59 percent of those without brain stem injury had sleep apnea.
The study was scheduled for presentation Wednesday at the American Stroke Association meeting in San Diego. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.
“This is the largest population-based study to address the issue of the location of the brain injury and its relationship to sleep apnea in post-stroke patients,” study lauthor Dr. Devin Brown, associate director of the stroke program at the University of Michigan in Ann Arbor, said in a stroke association news release.