Are stroke cases affected by sleep disordered breathings all the same?

Seep disordered breathings (SDB) affects outcome of stroke patients, consequently continuous positive airway pressure (CPAP) treatment is largely justified. Unfortunately, not all are compliant with CPAP, suggesting that it is not appropriate for everyone with OSA after stroke. People with the highest likelihood of benefiting have to be identified. We present one subdivision of cases with stroke and SDB to be adopted in order to identify possible best responders to CPAP treatment. Four different subgroups are proposed: 1. patients who terminate the apnoea by arousing from sleep; these cases are those affected either by an anatomical or a functional obstruction of upper airways that precede or else are the consequence of stroke on upper airways; 2. cases that alternate obstructive sleep apnoea (OSA) to central sleep apnoea (CSA) cause of a loop gain >1; 3. cases in who ischemic damaging processes have altered sleep microstructure (CAP). Increase in the number of CAP’s phases B can cause

Sleep disordered breathings (SDB) worsens the clinical prognosis of stroke patients. Continuous positive airway pressure (CPAP) is a promising effective treatment. Unfortunately, not all patients are compliant with CPAP, suggesting that it is not appropriate for all patients with obstructive sleep apnoea (USA) after stroke. People with the highest likelihood of benefiting have to be identified. We present a classification of cases with stroke and SDB to be adopted in order to identify the best responders to CPAP treatment. We propose to classify patients in four subgroups: (1) patients who terminate the apnoea by arousing from sleep; these cases are those affected either by an anatomical or a functional obstruction of upper airways that may precede or are the consequence of stroke; (2) cases that alternate OSA to central sleep apnoea (CSA) cause of an altered loop gain; (3) cases in whom ischemic damages have altered the sleep microstructure (CAP); (4) cases that manifest a CSA as the direct consequence of stroke on the central neuronal drive to breath. So far, no study has investigated the consequences of stroke on sleep microstructure. In order to better elucidate these relationships, when reviewing the PSG tracings of stroke patients, the microstructure of sleep should be systematically analysed. (C) 2014 Elsevier Ltd. All rights reserved.