Sleep-Disordered Breathing After Stroke

Sleep-disordered breathing is common after stroke and most often presents as obstructive sleep apnea (OSA), with an estimated prevalence between 43% and 70% compared with 4% and 24% in the general population.1–3 OSA is the result of partial or complete closure of the upper airway while attempting to breathe during sleep. It is characterized by snoring, hypopnea, and apnea with intermittent awakening accompanied by gasping or choking.1 Daytime sleepiness and fatigue are common features as well. The severity of OSA is measured using the apnea–hypopnea index, oxygen desaturations, and arousals during each hour of sleep.4 OSA after stroke has been shown to increase poststroke mortality and morbidity.2,5 Untreated, OSA may worsen cognition, functional outcome, and mood after stroke.6The purpose of this review is to provide nurses caring for patients who have had a stroke and those at risk for stroke with a brief review of sleep-disordered breathing after stroke, including epidemiology, pathophysiology, diagnostic work-up, and management. The contributions of the nurse as a member of the interprofessional team are emphasized, including direct and indirect care, patient education, quality improvement, and research.Pubmed and CINAHL databases were searched using the following key terms in all possible combinations: sleep-disordered breathing, obstructive sleep apnea, central sleep apnea, stroke, continuous positive airway pressure, guidelines, and evidence-based recommendations. Secondary references were obtained from the reference lists of primary publications found using the search criteria listed above.Sleep-disordered breathing after stroke presents as OSA or central sleep apnea (CSA) or both. OSA is more common than CSA after stroke, 30% to 70% versus 6% to 24%, respectively.3 Although OSA is the result of mechanical narrowing and collapse of the upper airway, CSA occurs because of lack of central respiratory drive.3 CSA may be associated …