Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2016; 4(2): 33-37
Published online Feb 16, 2016. doi: 10.12998/wjcc.v4.i2.33
Stroke and sleep-disordered breathing: A relationship under construction
Olga Parra, Adrià Arboix
Olga Parra, Service of Pneumology, Hospital Universitari del Sagrat Cor, University of Barcelona, E-08029 Barcelona, Spain
Adrià Arboix, Cerebrovascular Division, Service of Neurology, University of Barcelona, Hospital del Sagrat Cor, E-08029 Barcelona, Spain
Author contributions: Both authors contributed equally to the review of the literature, selection of the articles of interest and writing of the manuscript.
Conflict-of-interest statement: None to be declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adrià Arboix, MD, PhD, Cerebrovascular Division, Service of Neurology, University of Barcelona, Hospital del Sagrat Cor, C/ Viladomat 288, E-08029 Barcelona, Spain. aarboix@hscor.com
Telephone: +34-93-4948940 Fax: +34-93-4948906
Received: June 17, 2015
Peer-review started: June 17, 2015
First decision: September 29, 2015
Revised: October 14, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: February 16, 2016

The association between sleep-disordered breathing (SDB) and cardiovascular risk has been the focus of attention in recent years. Sleep disorders are emerging risk factors for cardiovascular disease and have been related to the whole spectrum of stroke, including transient ischemic attack, ischemic cerebral infarction and intracerebral haemorrhage. It has been shown that lacunar stroke or lacunar infarctions affecting the internal capsule or the protuberance are associated with a higher frequency of SDB. Acute stroke patients with associated SDB have a worse prognosis and a higher mortality as compared to patients with first-ever stroke without SDB. Preliminary studies provide evidence of the usefulness of treatment with continuous positive airway pressure when SDB is present in stroke patients.

Keywords: Apnea-hypopnea index, Cardiovascular risk factors, Continuous positive airway pressure, Ischemic stroke, Lacunar infarction, Sleep disordered

Core tip: Sleep disorders including obstructive sleep apnea are associated with an increased risk for a number of cardiovascular diseases, notably acute cerebrovascular events. A number of studies have shown a high prevalence of sleep-related breathing disorders in patients with stroke. A decrease in cerebral perfusion and increased coagulability related to metabolic, hematological and hemodynamic changes occuring in the presence of sleep-related breathing disorders are proposed as potential mechanisms in the pathogenesis of stroke. Early diagnosis and prompt therapeutic measures, including continuous positive airway pressure are necessary to reduce the stroke risk associated with sleep disorders. Sleep-related breating disorders should be considered modifiable risk factors for stroke, although they are frequenty underdiagnosed. The relationship between sleep breathing disorders and stroke should be further investigated for improving primary and secondary stroke prevention strategies and to contribute to reduce the global burden of stroke.