Exzessive Tagesschläfrigkeit bei Patienten mit zerebrovaskulären Erkrankungen und obstruktiver Schlafapnoe

Background: Cerebrovascular events are among the leading main causes of death and often lead to lifelong disability and invalidity. So far the influence of obstructive sleep apnea on cerebrovascular events and vice versa, is either still largely unknown or has not yet been investigated sufficiently. The most common usual indication for the diagnosis and treatment of obstructive sleep apnea is increased daytime sleepiness. Former studies suggest that patients who had experienced a cerebrovascular event with accompanying obstructive sleep apnea did not suffer from increased daytime sleepiness. Therefore we tested if patients after a cerebrovascular event despite a coexisting obstructive sleep apnea do not suffer from increased sleepiness. Furthermore we investigated if this phenomenon goes hand in hand with an altered nocturnal rest period, regardless of their employment status. Next, we compared whether patients who had experienced a cerebrovascular event accompanied by obstructive sleep apnea, differ in their characteristic variables from patients suffering from obstructive sleep apnea only. We wanted to find out if there are differences in nocturnal sleeping patterns and whether the two groups of patients differ with regards to their sleep quality in diagnostic polysomnography and under stable CPAP. Method: We conducted a retrospective case-control study of a cohort of 675 patients with obstructive sleep apnea, examined 26 patients who had experinced a cerebrovascular event and used another 26 patients who were parallelized by age, sex, height, weight, employment status and apnea-hypopnea index as a control group. Therefore we used data from the clinical history, as well as the diagnostic polysomnography and subsequent CPAP therapy under polysomnographic control. 53 Results: In comparison with control patients, patients after a cerebrovascular event had a significantly lower Epworth Sleepiness Scale score (8,5 ± 3,3 vs. 13,1 ± 4,8 (p<,001)). According to the current definition of excessive daytime sleepiness (ESS ≥ 11) 6 out of 26 patients with a cerebrovascular event and 16 out of 26 control patients fall under the category of excessive daytime sleepiness (p=,004). Furthermore, after a cerebrovascular event patients reported a higher habitual sleep time during the week from 521,9 ± 91,0 vs. 461,0 ± 66,9 minutes (p<,001). The sleep-related breathing disorder in the chronic phase of the cerebrovascular event does not differ significantly in the variables of diagnostic polysomnography and under stable CPAP. Conclusion: Patients suffering from cerebrovascular disease and obstructive sleep apnea report a significantly lower pronounced habitual daytime sleepiness than matched patients without cerebrovascular diseases. For this phenomenon which was already observed by other authors, this work can present an explanation for the first time illustrated by the observably extended reported sleep time of patients with cerebrovascular disease. It remains to be seen however, whether the plausible context, longer sleep time - less daytime sleepiness is causal or whether, for example cerebrovascular disease has influence on both sleep perception as well as alertness experience. The sleep- related breathing disorder in patients during the chronic phase of the cerebrovascular event, does not differ significantly in the variables of diagnostic polysomnography and treatment with CPAP.