sleep disordered breathing; stroke; ischemic lesion volume; funcional connectivity; penumbra; early ASV therapy; recovery
Brill Anne-Kathrin, Horvath Thomas, Seiler Andrea, Camilo Millene, Haynes Alan G, Ott Sebastian R, Egger Matthias, Bassetti Claudio L (2018), CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials., in Neurology
, 90(14), e1222-e1230.
Pincherle Alessandro, Pace Marta, Sarasso Simone, Facchin Laura, Dreier Jens P, Bassetti Claudio L (2018), Sleep, Preconditioning and Stroke., in Stroke
, 48(12), 3400-3407.
Ott Sebastian Robert, Korostovtseva Lyudmila, Schmidt Markus, Horvath Thomas, Brill Anne-Kathrin, Bassetti Claudio L (2017), Sleep-disordered breathing: clinical features, pathophysiology and diagnosis., in Swiss medical weekly
, 147, 14436-14436.
Duss Simone B., Seiler Andrea, Schmidt Markus H., Pace Marta, Adamantidis Antoine, Müri René M., Bassetti Claudio L. (2016), The role of sleep in recovery following ischemic stroke: A review of human and animal data, in Neurobiology of Sleep and Circadian Rhythms
, 2, 94-105.
Camilo Millene R., Schnitman Saul V., Sander Heidi H., Eckeli Alan L., Fernandes Regina M.F., Leite Joao P., Bassetti Claudio L., Pontes-Neto Octavio M. (2016), Sleep-disordered breathing among acute ischemic stroke patients in Brazil, in Sleep Medicine
, 19, 8-12.
Brill Anne-Kathrin, Rösti Regula, Hefti Jacqueline Pichler, Bassetti Claudio, Gugger Matthias, Ott Sebastian R (2014), Adaptive servo-ventilation as treatment of persistent central sleep apnea in post-acute ischemic stroke patients., in Sleep medicine
, 15(11), 1309-13.
Background:Sleep loss and sleep disorders (such as sleep disordered breathing (SDB), restless legs with periodic limb movements (RLS/PLMS) and insomnia (I)) are associated with hypertension and/or cardio-cerebrovascular morbidity and mortality. A number of studies suggests that sleep disorders (in particular SDB) are frequent after stroke. Their exact frequency and impact on short- and long-term outcome of stroke remain, however, poorly known. Working hypotheses:1) SDB has a detrimental effect on the spatial extension of ischemic penumbra and lesion volume as well as on the reorganization of functional networks of the brain during the first 3 months after stroke2) these negative effects are related to hemodynamic and inflammatory changes e.g. changes in matrix metalloproteinases (MMP), tissue inhibitors of metalloproteinases (TIMP) and adhesion molecules that can be reversed with Adaptive Servo-Ventilation (ASV) used to treat central, obstructive and mixed forms of SDB3) sleep loss (duration<6h) and sleep disorders (SDB, RLS/PLMS, I) have detrimental effects on outcome and risk of cardiovascular events in the first 12 months after stroke.Patients and methods:1) In a first interventional study (project 1) 150-200 patients with acute non-lacunar, anterior circulation, moderate to severe (NIH stroke scale score 4-20) ischemic stroke from one single centre (Bern) will be recruited over 2.75 years. Assessments will include stroke scales/ aetiology; cerebral MRI to assess the ischemic penumbra and the ischemic lesion volume (perfusion and diffusion imaging), functional connectivity (resting state fMRI) and longitudinal grey matter changes; respiratory polygraphy (RP, within the first night after stroke onset); 24h blood pressure and blood measurements (inflammatory markers). Patients with an AHI = 20 (significant SDB, sSDB) will be randomized to treatment with ASV or no treatment after RP (within 48h after stroke). After 5-7 days brain MRI (to assess evolution of the penumbra, the lesion volume and baseline functional connectivity measures) and blood measurements will be performed. After 3 months cerebral MRI, 24h blood pressure and blood measurements will be repeated and clinical outcome assessed. MRI and clinical evolution will be compared at 5-7 days and at 3 months in patients with sSDB+ASV, sSDB-ASV and patients without SDB (AHI = 10).2) Independent from the first project, about 1000 stroke patients from two centres (Bern and Lugano) will be included over 2 years for an observational study (project 2). During the acute phase assessments will include stroke scales/aetiology, sleep-wake questionnaires (assessing sleep duration, sleep quality, and other variables) and - in every 5th patient - actigraphy. All patients will be treated according to current best standards. Stroke outcome and frequency of new cardiovascular events will be assessed at discharge, after 3 months and 1 year.Expected Value of the project:This project will improve our understanding of frequency as well as short- and long-term clinical relevance, physiological mechanisms, and treatment implications of sleep loss and sleep disorders (SDB, RLS/PLMS, I) after stroke.