Optimization of Early Rehabilitation of Patients with Ischemic Stroke and Sleep-Disordered Breathing

Аннотация

Introduction: Sleep-disordered breathing (SDB) is detected in 70% of stroke patients and impedes functional rehabilitation; it also increases the length of hospital stay and the risk of stroke recurrence and fatal outcome. Objective: To study the dynamics of SDB in its correlation with neurological disorders in stroke patients and to develop the approaches to optimization of early rehabilitation. Materials and methods: Seventy eight patients with acute ischemic stroke were examined. SDB was verified by cardiorespiratory monitoring; neurological deficit was assessed with the NIHSS and mRS scales. Examination was performed upon admission (days 2–5 post stroke) and repeated 3 weeks after. The effect of SDB correction on neurological recovery was studied for positional therapy (elevated head of bed by 30°) in combination with oxygen therapy (insufflation of O₂ with maintenance of saturation level not less than 95% under digital sensor control). Results: Upon admission, SDB was revealed in 88% of patients; moderate and severe disorders being predominant (the apnea/hypopnea index (AHI) ≥ 15 h^–1), most frequently presenting as obstructive apnea. In patients with AHI < 15 h^–1, the positive dynamics of neurological disorders (p < 0.04) was observed along with stable SDB parameters. Neurological improvement (р < 0.05) was present in patients with AHI ≥ 15 h^–1, which was associated with lesser severity of SDB. A direct correlation between the severity of neurological disorders and AHI after 3 weeks from the onset was revealed: R_NIHSS/AHI = 0.45 (р = 0.003) and R_mRS/AHI = 0.44 (р = 0.004). Patients with AHI ≥ 15 h^–1 were divided into 2 groups: group A (no interventions) and group B (with application of positional and oxygen therapy in the night sleep during 7 days). A positive effect of therapy on restoration of neurological functions, along with a decrease in AHI, was revealed. Conclusions: SDB is a frequent and persistent disorder in patients with ischemic stroke. Early detection and correction of SDB should be regarded as an important component of post-stroke rehabilitation.