Sleep patterns in acute ischemic stroke Giubilei F, Iannilli M, Vitale A, Pierallini A, Sacchetti ML, Antonini G, Fieschi C. Sleep patterns in acute ischemic stroke. Acta Neurol Scand 1992: 86: 567-571. 0 Munksgaard 1992.
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We studied polysomnographic recordings using an Oxford Medilog 9000 System in 18 patients with ischemic stroke in the middle cerebral artery territory. All patients underwent neurologic examination and brain CT scan within 5 h after the onset of symptoms. Polysomnographic recordings were started immediately thereafter and went on for three nights. Clinical and polysomnographic follow-up were performed 3 weeks after admission. The number and duration of REM phases were significantly reduced in the acute phase. This reduction correlated with the severity of neurological deficit at outcome and with the anatomical site of the lesion on CT scan. Our data provide evidence that polysomnographic recording is useful to detect symptoms of patients with different clinical outcomes during the acute phase of ischemic stroke.
Sleep patterns in humans are generally altered following cerebrovascular brainstem lesions (1-5), and the prognostic value of sleep variations has been reported both in cerebrovascular disease (6-8) and in post-traumatic coma (9, 10). In experimental ischemia a degradation of the electroencephalographic sleep-waking cycle has been found in the first postischemic days, with gradual normalization in the animals that survived (11). However, except for an isolated case report (12), no data are available on sleep patterns during the first few days of a supratentorial stroke in man, as well as on longitudinal polysomnographic-clinical correlations. The aim of our study was to determine the sleep morphology and its clinical predictive value and to evaluate the relation between site of lesion and sleep alteration in patients with acute cerebral ischemia in the carotid territory of distribution. Material and methods
We studied polysomnographic recordings in 18 consecutive patients (10 men and 8 women, mean k SD age 66.3 & 10 years, range 49-78) with ischemic stroke in the middle cerebral artery (MCA) territory. Three additional patients, initially recruited, needed sedation after the first night and were excluded. Diagnosis of ischemic stroke was based on neurological examination and CT scan findings. Patients with a history of previous stroke, subtentorial signs and symptoms, alteration of level of consciousness or agitation on admission were note included. Patients with minor or regressing neurological deficit were also excluded (Canadian Neurological Scale 2 8.5, see below). Particular attention was payed to
F. Giubilei, M. lannilli, A. Vitale, A. Pierallini, M. L. Sacchetti, G. Antonini, C. Fieschi Department of Neurological Sciences, University of Rome "La Sapienza", Rome, Italy
Key words: sleep; stroke; prognosis Franco Giubilei, Dipartimento di Scienze Neurologiche, V. Le Dell' Universita, 30, 0 0 1 8 5 Roma - ltalia Accepted for publication May 25, 1 9 9 2
exclude patients with history of sleep pattern disturbances or who had taken drugs known to affect sleep patterns before the event. Patients were hospitalized soon after stroke, and within 5 h after the onset of symptoms, all of them underwent neurologic examination and brain CT scan. Polysomnographic recordings were started immediately thereafter. Patients were given standard therapies, as required by their clinical status, avoiding drugs known to modify sleep pattern. In the acute phase of stroke, three 24-h recordings could not be performed for technical reasons. Therefore, mean values refer to 17 second nights and 16 third nights. Neurologic status was evaluated daily for up to 3 weeks and graded according to the Canadian Neurological Scale (CNS) (13). On admission, the degree of neurologic impairment was classified as mild (CNS score between 6.5 and 8.5) in 7 patients or severe (CNS score of
1
We studied polysomnographic recordings using an Oxford Medilog 9000 System in 18 patients with ischemic stroke in the middle cerebral artery territory. All patients underwent neurologic examination and brain CT scan within 5 h after the onset of symptoms. Polysomnographic recordings were started immediately thereafter and went on for three nights. Clinical and polysomnographic follow-up were performed 3 weeks after admission. The number and duration of REM phases were significantly reduced in the acute phase. This reduction correlated with the severity of neurological deficit at outcome and with the anatomical site of the lesion on CT scan. Our data provide evidence that polysomnographic recording is useful to detect symptoms of patients with different clinical outcomes during the acute phase of ischemic stroke.
Sleep patterns in humans are generally altered following cerebrovascular brainstem lesions (1-5), and the prognostic value of sleep variations has been reported both in cerebrovascular disease (6-8) and in post-traumatic coma (9, 10). In experimental ischemia a degradation of the electroencephalographic sleep-waking cycle has been found in the first postischemic days, with gradual normalization in the animals that survived (11). However, except for an isolated case report (12), no data are available on sleep patterns during the first few days of a supratentorial stroke in man, as well as on longitudinal polysomnographic-clinical correlations. The aim of our study was to determine the sleep morphology and its clinical predictive value and to evaluate the relation between site of lesion and sleep alteration in patients with acute cerebral ischemia in the carotid territory of distribution. Material and methods
We studied polysomnographic recordings in 18 consecutive patients (10 men and 8 women, mean k SD age 66.3 & 10 years, range 49-78) with ischemic stroke in the middle cerebral artery (MCA) territory. Three additional patients, initially recruited, needed sedation after the first night and were excluded. Diagnosis of ischemic stroke was based on neurological examination and CT scan findings. Patients with a history of previous stroke, subtentorial signs and symptoms, alteration of level of consciousness or agitation on admission were note included. Patients with minor or regressing neurological deficit were also excluded (Canadian Neurological Scale 2 8.5, see below). Particular attention was payed to
F. Giubilei, M. lannilli, A. Vitale, A. Pierallini, M. L. Sacchetti, G. Antonini, C. Fieschi Department of Neurological Sciences, University of Rome "La Sapienza", Rome, Italy
Key words: sleep; stroke; prognosis Franco Giubilei, Dipartimento di Scienze Neurologiche, V. Le Dell' Universita, 30, 0 0 1 8 5 Roma - ltalia Accepted for publication May 25, 1 9 9 2
exclude patients with history of sleep pattern disturbances or who had taken drugs known to affect sleep patterns before the event. Patients were hospitalized soon after stroke, and within 5 h after the onset of symptoms, all of them underwent neurologic examination and brain CT scan. Polysomnographic recordings were started immediately thereafter. Patients were given standard therapies, as required by their clinical status, avoiding drugs known to modify sleep pattern. In the acute phase of stroke, three 24-h recordings could not be performed for technical reasons. Therefore, mean values refer to 17 second nights and 16 third nights. Neurologic status was evaluated daily for up to 3 weeks and graded according to the Canadian Neurological Scale (CNS) (13). On admission, the degree of neurologic impairment was classified as mild (CNS score between 6.5 and 8.5) in 7 patients or severe (CNS score of
