Sleep apnea, delirium, depressed mood, cognition, and ADL ability after stroke

OBJECTIVES: The incidence of sleep apnea and stroke increases with age. The aim of this study was to investigate the presence of sleep apnea after str oke and its relationship to delirium, depressed mood, cognitive functioning , ability to perform activities of daily living (ADLs), and psychiatric and behavior symptoms. DESIGN: Cross-sectional study. SETTING: Geriatric stroke rehabilitation unit. PARTICIPANTS: 133 patients (78 women and 55 men, mean age 77.1 +/- 7.7 year s) consecutively admitted to a geriatric stroke rehabilitation unit. MEASUREMENTS: All patients underwent overnight respiratory sleep recordings at 23 +/- 7 days (range 11 to 41 days) after suffering a stroke. The patie nts were assessed using the Organic Brain Syndrome Scale, Montgomery-Asberg -Depression-Rating Scale, Mini-Mental State Examination (MMSE), and Barthel -ADL Index. Sleep apnea was defined as an apnea-hypopnea index (AHI) of 10 or more. RESULTS: The median of the AHI for the studied sample (N = 133) was 13 (ran ge 0-79; interquartile range 6-28). Fifty-nine percent fulfilled the criter ia for sleep apnea; 52% with first-ever stroke had sleep apnea. More patien ts with sleep apnea than without were delirious, depressed, or more ADL-dep endent. Sleep apnea patients also had a higher frequency of ischemic heart disease and had more often suffered from an earlier cerebral infarction. Mu ltivariate analysis showed that obesity, low ADL scores, ischemic heart dis ease, and depressed mood were independently associated with sleep apnea. Lo w ADL scores, apnea-related hypoxemia, body mass index less than or equal t o 27, and impaired vision were independently associated with delirium. The presence of sleep apnea was not associated with any specific type of stroke or location of the brain lesion. CONCLUSIONS: Sleep apnea is common in stroke patients and is associated wit h delirium, depressed mood, latency in reaction and in response to verbal s timuli, and impaired ADL ability. We suggest a trial investigating whether delirium, depressed mood, and ADL ability improve with nasal continuous pos itive airway pressure treatment of sleep apnea in stroke patients.