Stroke
SDB and Sleep-wake disorders have Detrimental
? Psychiatric function
? neurological function
o Increased stroke recurrence
o Increased Long term mobidity post stroke
Definition: Stroke is a focal neurological deficit of acute onset and vascular origin
2 to 18% p.a.
Types:
? TIA ? neurological deficit resolves within 24 hours. 20% of acute CVA
? Intracerebral hemorrhage 15%
?
Ischemic Stroke 65%


Risk factors:
1. Arterial fibrillation
2. Age >65
3. Arterial HT
4. Heart Disease
5. Asymptomatic Carotid stenosis
6. History of TIA
7. Alcohol and Tobacco use
8. DM
9. Hypercholesterolemia
10. Sleep Disordered Breathing (Toast Trial 2004 ? 10172 patients

Management of Acute Stroke
1. Stroke unit
2. Fibrinolytic agents in the 1st 3-6 hours after ischemic stroke
3. Neuroprotective agents
4. Endvascular stenting / balloon dilatation
5. Surgery for haemorrhage
Primary Prevention: Manage risk factors, anticoagulation for AF, endarterectomy for carotid stenosis >70%. Aspirin and anti HT treatment


Chynes Stokes breathing follow stroke
Hypersomnia follows stroke (1830) ? Thelamic and mesencephalic stroke (midbran)


SDB
Epidemiology:
? 60 to 70% of all stroke patients exhibit SDB ? AHI>10 (Neurology 1996)
? SDB precedes stroke
? Prestroke cerebrovascular disease and white matter disease on CT were linked with more severe poststroke SDB
Pathogenesis:
? SDB as a consequence of stroke
? OSA is aggravated by stroke
? OSA appears denovo after stroke
? Disturbed coordination of upper airways, intercostals muscles, diaphragm due to brainstem or hemispheric lesions
? Rostrolateral medullary lesions
? CSB ? Chyne