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Sleep loss and sleep disorders and their impact on the short- and longterm outcome of stroke

English title Sleep loss and sleep disorders and their impact on the short- and longterm outcome of stroke
Applicant Bassetti Claudio L.
Number 149752
Funding scheme Project funding (Div. I-III)
Research institution Universitätsklinik für Neurologie Inselspital Universität Bern
Institution of higher education University of Berne - BE
Main discipline Neurology, Psychiatry
Start/End 01.03.2014 - 28.02.2018
Approved amount 595'000.00
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Keywords (7)

sleep disordered breathing; stroke; ischemic lesion volume; funcional connectivity; penumbra; early ASV therapy; recovery

Lay Summary (German)

Lead
Schlaf ist zentral für die körperliche sowie psychische Regeneration. Schlafstörungen hingegen, wie Schlafapnoe, Restless Legs Syndrom und Insomnie sind mit Bluthochdruck, sowie kardio-vaskulärer Morbidität und Mortalität assoziiert. Mehr als 50% der Schlaganfallpatienten leiden an einer schlafbezogenen Atemstörung und 20-40% sind von einer Störung des Schlaf-Wach-Rhythmus betroffen. Aufgrund der hohen Prävalenz von Schlafstörungen nach Schlaganfall und ihrer negativen gesundheitlichen Folgen, ist eine Früherkennung und unmittelbare Behandlung zur Optimierung des Rehabilitationsprozesses der Betroffenen von zentraler Bedeutung.
Lay summary

Inhalte und Ziele des Forschungsprojekts

Das gesamte Forschungsprojekt ist zweigeteilt. In der Interventionsstudie wird untersucht, ob eine unmittelbare Behandlung des Schlafapnoe-Syndroms mittels nächtlicher Überdrucktherapie den Verlauf des Schlaganfalles günstig beeinflusst. Ziel der Beobachtungsstudie ist es, die Häufigkeit der Schlafstörungen nach Schlaganfall zu erfassen und deren Einfluss auf den Rehabilitationsprozess zu beschreiben. Hierbei werden über 1000 Patienten mit akutem Schlaganfall oder transienten ischämischen Attacken aus zwei Zentrum (Inselspital Bern, Universitätsklinik für Neurologie und Neurocentro della Svizzera Italiana, Lugano) rekrutiert.

Wissenschaftlicher und gesellschaftlicher Kontext

Das vorliegende Projekt strebt ein besseres Verständnis zu den Häufigkeiten, den Formen und der Behandlungseffektivität von Schlafstörungen nach Schlaganfall an, sowie zu deren Einfluss auf den Rehabilitationsverlauf. Ein solches verbessertes Verständnis ist für die Bereitstellen der bestmöglichen Behandlung der Patienten nach Schlaganfall von zentraler Bedeutung. Wissenschaftliche Evidenz für einen besseren Rehabilitationsverlauf nach Schlaganfall bei unmittelbarer Behandlung der Schlafapnoesymptomatik versus keiner Behandlung würde eine Veränderung der klinischen Routine mit sich bringen.

Direct link to Lay Summary Last update: 12.05.2014

Responsible applicant and co-applicants

Employees

Project partner

Publications

Publication
Cardiac autonomic dynamics during sleep are lost in patients with TIA and stroke
Tobaldini Eleonora, Proserpio Paola, Oppo Valentina, Figorilli Michela, Fiorelli Elisa M., Manconi Mauro, Agostoni Elio C., Nobili Lino, Montano Nicola, Horvath Thomas, Bassetti Claudio L. (2019), Cardiac autonomic dynamics during sleep are lost in patients with TIA and stroke, in Journal of Sleep Research, e12878-e12878.
Prevalence of sleep-disordered breathing after stroke and TIAA meta-analysis
Seiler Andrea, Camilo Millene, Korostovtseva Lyudmila, Haynes Alan G., Brill Anne-Kathrin, Horvath Thomas, Egger Matthias, Bassetti Claudio L. (2019), Prevalence of sleep-disordered breathing after stroke and TIAA meta-analysis, in Neurology, 92(7), e648-e654.
Sleep-disordered breathing and stroke: chicken or egg?
Alexiev Filip, Brill Anne-Kathrin, Ott Sebastian R., Duss Simone, Schmidt Markus, Bassetti Claudio L. (2018), Sleep-disordered breathing and stroke: chicken or egg?, in Journal of Thoracic Disease, 10(S34), S4244-S4252.
Sleep-Wake Disorders in Stroke—Increased Stroke Risk and Deteriorated Recovery? An Evaluation on the Necessity for Prevention and Treatment
Duss Simone B., Brill Anne-Kathrin, Bargiotas Panagiotis, Facchin Laura, Alexiev Filip, Manconi Mauro, Bassetti Claudio L. (2018), Sleep-Wake Disorders in Stroke—Increased Stroke Risk and Deteriorated Recovery? An Evaluation on the Necessity for Prevention and Treatment, in Current Neurology and Neuroscience Reports, 18(10), 72-72.
Rapid eye movements sleep as a predictor of functional outcome after stroke: a translational study
Pace Marta, Camilo Millene R, Seiler Andrea, Duss Simone B, Mathis Johannes, Manconi Mauro, Bassetti Claudio L (2018), Rapid eye movements sleep as a predictor of functional outcome after stroke: a translational study, in Sleep, 41(10), 1-11.
CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials.
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.
Schlaf, neuronale Plastizität und Erholung nach einem Hirnschlag
DUSS SIMONE, SEILER ANDREA, MÜRI RENÉ, BASSETTI CLAUDIO (2018), Schlaf, neuronale Plastizität und Erholung nach einem Hirnschlag, in Schlaf, 04(02), 72-77.
Sleep, Preconditioning and Stroke.
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.
Die Rolle des Schlafes in der Neurorehabilitation nach einem Hirninfarkt und traumatischen Hirnverletzungen
Lippert Julian, Duss Simone, Seiler Andrea, Müri René, Bassetti Claudio L. (2017), Die Rolle des Schlafes in der Neurorehabilitation nach einem Hirninfarkt und traumatischen Hirnverletzungen, in Therapeutische Umschau, 74(9), 479-484.
Sleep-disordered breathing: clinical features, pathophysiology and diagnosis.
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.
The role of sleep in recovery following ischemic stroke: A review of human and animal data
Duss Simone B., Seiler Andrea, Schmidt Markus H., Pace Marta, Adamantidis Antoine, Müri René M., Bassetti Claudio L. (2017), 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.
Sleep-disordered breathing among acute ischemic stroke patients in Brazil
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.
Adaptive servo-ventilation as treatment of persistent central sleep apnea in post-acute ischemic stroke patients.
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.

Collaboration

Group / person Country
Types of collaboration
Dr. M. Manconi, Centro Sonno/Epilessia, Neurocentro della Svizzera Italiana Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Stephen Laib, Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
4th SFCNS Congress Poster Sleep-wake Patterns after Stroke: A prospective study of 438 patients 23.10.2019 Lausanne, Switzerland Bassetti Claudio L.;
4th SFCNS Congress Poster Sleep-wake disturbances after ischemic stroke or transient ischemic attacks as predictors of new cardio-cerebro-vascular events and outcome 23.10.2019 Lausanne, Switzerland Bassetti Claudio L.;
5th Congress of the European Academy of Neurology - Oslo 2019 Talk given at a conference Sleep-wake disturbances after ischemic stroke/transient ischemic attack: frequency and evolution 29.06.2019 Oslo, Norway Gorban Corina; Bassetti Claudio L.; Seiler Andrea;
Annual Meeting 2017 of the Swiss Neurology Society Poster Sleep-wake changes and disturbances and their impact on the short- and long-term outcome of stroke - a two-center prospective observational cohort study: Update on the descriptive analysis of the first 360 patients 28.09.2017 Interlaken, Switzerland Kuen Doris; Ott Sebastian Robert; Gorban Corina; Bassetti Claudio L.; Manconi Mauro;
22nd European Sleep Research Society (ESRS) Congress Poster Sleep loss and sleep disorders and their impact on the short- and long-term outcome of stroke 16.09.2014 Tallinn, Estonia Manconi Mauro; Bassetti Claudio L.; Ott Sebastian Robert; Seiler Andrea; Oberholzer Michael;


Awards

Title Year
Poster Prize at the Annual Congress 2017 of the Swiss Neurological Society SNS. "Sleep-wake changes and disturbances and their impact on the short- and long-term outcome of stroke - a two-center prospective observational cohort study: Update on the descriptive analysis of the first 360 patients" S Duss1; D Kuen 1; C Gorban1; T Horvath1; A Brill1; S Ott1; G Chiaro2; M Manconi2; C Bassetti1 1Bern University Hospital (Inselspital); 2Civic Hospital (EOC) of Lugano 2017

Associated projects

Number Title Start Funding scheme
166827 Early Sleep Apnea Treatment in Stroke: A Randomized, Rater-Blinded, Clinical Trial of Adaptive Servo-Ventilation 01.06.2016 Investigator Initiated Clinical Trials (IICT)

Abstract

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.
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