RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE

Abstract

SUMMARY S leep disordered breathing is a frequent comorbidity in stroke patients. SDB is one of the independent risk factors for ischemic stroke. Conversely, stroke may contribute to SDB onset or aggravate premorbid SDB. Multiple mechanisms underlying SDB might be responsible for the development of stroke. In the present study we sought to evaluate the relationship between sleep disordered breathing and atherogenic pro-inflammatory markers in acute ischemic stroke patients. Thirty patients were recruited, Age between 50 and 70 years old, with acute ischemic stroke within the first week of stroke from Ain Shams university hospitals and Egypt air hospital and matched with thirty individuals as a control group by age and sex. Patients with the following criteria were exclude; Patients with medical illnesses affecting their sleep pattern and Patients with history of drug intake that could affect respiratory effort during sleep such as hypnotics or sedatives. All subjects completed sleep questionnaire and SA-SDQ and patients were assessed clinically using the NIHSS score and the modified Rankin scale. MRI brain stroke protocol was performed to all patients. Overnight polysomnography was performed and Morning blood sample collection for all subjects including biomarkers; IL-6, TNF-a, CRP and serum fibrinogen and platelets. Control group was subjected to sleep questionnaire, SA-SDQ, PSG and biomarkers. Comparison between both group showed that Patients had DM (43%) and HTN (73.3%), reduced Sleep efficiency, increased arousal, increased N1 percentage, reduced N2 percentage, reduced REM percentage, increased PLM, severe increase in snore index and high respiratory distress during sleep shown by high RDI. Also biomarkers IL-6, CRP, fibrinogen and platelets were increased in stroke patients with highly significant difference in comparison to control. TNFa was higher in patients but not statistically significant. Patients were further divided into normal RDI group (5 patients) and abnormal RDI >5 apnea group (25 patients), to evaluate the relationship between stroke and OSA. We found that IL-6, TNFa and CRP were higher in abnormal RDI group but not statistically significant due to difference in numbers of patients in both groups. Our findings support previous studies that shows higher percentage of OSA in stroke patients. This proves a role of inflammation in the relation between OSA and stroke. This study supports that there is interaction between stroke and SDB, especially OSA. As we have seen in this