Sleep apnea in stroke: Diagnosis, consequences & treatment

Obstructive sleep apnea (OSA) is the most common sleep disorder in stroke, but is often left unrecognized and untreated. When left untreated, OSA is thought to contribute to decreased recovery from stroke. The main objectives of this thesis were 1) to improve early recognition of sleep apnea in stroke patients during inpatient rehabilitation, 2) to examine the effects of OSA on daily functioning of stroke patients at admission to stroke rehabilitation, and 3) to investigate whether treatment with continuous positive airway pressure (CPAP) could ameliorate the recovery of cognitive and functional outcome after stroke. First, we found that a stepped-diagnostic approach to sleep apnea, including a prediction model and nocturnal oximetry, can be considered an adequate and feasible screening method for sleep apnea during stroke rehabilitation. Our second main finding was that OSA patients were significantly more impaired on both cognitive and functional status than stroke patients without OSA. More specifically, OSA patients were more impaired in the cognitive domains of attention, executive functioning, visuoperception, psychomotor ability and intelligence, and had poorer neurological status and a lower level of functional independence. Our third conclusion was that CPAP treatment improves cognitive functioning of stroke patients in the domains of attention and executive functioning, while we did not find improvement of functional status. These beneficial effects on cognition offer preliminary evidence for the use of CPAP treatment as part of a rehabilitation program for stroke patients.