Identifying neurological comorbidities in obstructive sleep apnea patients through polysomnography
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • LETTER TO THE EDITORS
Identifying neurological comorbidities in obstructive sleep apnea patients through polysomnography Lothar Burghaus 1,2
&
Lisa Piano 3 & Gereon R. Fink 2,4 & Lennart Knaack 3
Received: 9 July 2020 / Revised: 12 October 2020 / Accepted: 15 October 2020 # The Author(s) 2020
To the Editor, Obstructive sleep apnea (OSA) is a common disease characterized by recurrent respiratory flow limitations and closure of the upper airway accompanied by repetitive hypoxia during sleep. Increased arousal activity, sleep fragmentation, and disturbed sleep architecture cause cardinal symptoms like excessive daytime sleepiness and impaired quality of life. OSA is associated with an increased risk of complications such as stroke or cardiovascular events. In males with severe OSA, the risk of a cerebrovascular event is nearly three times higher [1]. Likewise, sleep-related breathing and sleep-wake disturbances frequently occur in ischemic stroke. More than 50% of stroke patients have sleep-related breathing disturbances, presenting with obstructive, central, or mixed apneas [2]. Recently, in this journal, Leino et al. discussed specific polysomnographic features of acute stroke and TIA patients with OSA [3]. Stroke patients are of particular interest because OSA is a significant risk factor for cerebral ischemia, and, vice versa, cerebrovascular lesions can cause sleep disorders [4]. In stroke patients, the treatment of OSA impacts the outcome. Stroke patients with an apnea-hypopnea index (AHI) > 20 effectively treated by continuous positive airway pressure (CPAP) had a significantly better neurological outcome after 1 month than the control group without CPAP treatment [5]. Consequently,
* Lothar Burghaus [email protected] 1
Department of Neurology, Heilig Geist-Hospital, Grasegger Str. 105, 50737 Cologne, Germany
2
Department of Neurology, University Hospital Cologne, Cologne, Germany
3
Intersom Köln, Center of Sleep Medicine and Sleep Research, Cologne, Germany
4
Inst. of Neuroscience and Medicine (INM-3), Forschungszentrum Juelich, Juelich, Germany
stroke patients should be screened for sleep apnea after acute cerebral ischemia to start treatment as soon as possible [4]. We screened a large group of sleep laboratory patients with OSA for neurological comorbidities and looked for abnormalities of polysomnographic parameters that might help to identify neurological comorbidities. We analyzed 776 patients diagnosed with at least mild OSA (AHI ≥ 5/h). According to current standards, all patients had a suspected diagnosis of OSA and, therefore, underwent polysomnography. We next compared polysomnographic parameters between patients with OSA who additionally had a history of neurological disease and those who did not have any diagnosed neurological comorbidities. The data were also analyzed for each neurological disease, e.g., cerebral ischemia or neurodegenerative diseases. In a further step, significant differences in the parameters were examined a
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