Nocturnal desaturation is associated with neurological deterioration following ischemic stroke

A retrospective observational study

Tae Jung Kim, Sang Bae Ko, Han Gil Jeong, Chi Kyung Kim, Yerim Kim, Kiwoong Nam, Heejung Mo, Sang Joon An, H. Alex Choi, Byung Woo Yoon

Research output: Contribution to journalArticle

Abstract

Study Objectives: The mechanism of early neurological deterioration (END) in patients with stroke remains unclear. We assessed the relationship between nocturnal oxygen desaturation (NOD) in the stroke unit (SU) and END, especially occurring at nighttime, following acute stroke. Methods: A retrospective analysis was performed on a total of 276 patients with ischemic stroke who were admitted to the SU between July 2013 and June 2015. The oxygen desaturation index was calculated from pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 pm to 7:00 am) after admission, and NOD was defined as oxygen desaturation index ≥ 5 events/h. END was defined as an increase of ≥ 2 points from the baseline National Institutes of Health Stroke Scale during 7 days after onset. We compared clinical characteristics and NOD between patients with and without END. Results: Among the included patients (mean age 69.2; male 55.4%), 42 patients (15.2%) experienced END. The proportion of NOD was significantly greater in the END group (45.2% versus 12.8%, P < .001). After adjusting for confounders, NOD was independently associated with END (odds ratio 7.57; 95% confidence interval 3.14-18.27). Among END patients, 47.6% patients (n = 20) had END during nighttime. Moreover, NOD was more frequent in patients with END during nighttime compared to those with END during daytime (73.7% versus 26.1%, P = .002). Conclusions: NOD in the SU was associated with END, especially during nighttime, after ischemic stroke. This suggests that treatment of sleep-disordered breathing could be a modifiable factor to possibly reduce the risk of neurological worsening among acute stroke patients.

Original languageEnglish
Pages (from-to)1273-1279
Number of pages7
JournalJournal of Clinical Sleep Medicine
Volume13
Issue number11
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Observational Studies
Retrospective Studies
Stroke
Oxygen
Oximetry
Sleep Apnea Syndromes
National Institutes of Health (U.S.)
Odds Ratio
Confidence Intervals

Keywords

  • During nighttime
  • Early neurological deterioration
  • Nocturnal desaturation
  • Sleep-disordered breathing
  • Stroke unit

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

Nocturnal desaturation is associated with neurological deterioration following ischemic stroke : A retrospective observational study. / Kim, Tae Jung; Ko, Sang Bae; Jeong, Han Gil; Kim, Chi Kyung; Kim, Yerim; Nam, Kiwoong; Mo, Heejung; An, Sang Joon; Choi, H. Alex; Yoon, Byung Woo.

In: Journal of Clinical Sleep Medicine, Vol. 13, No. 11, 01.01.2017, p. 1273-1279.

Research output: Contribution to journalArticle

Kim, Tae Jung ; Ko, Sang Bae ; Jeong, Han Gil ; Kim, Chi Kyung ; Kim, Yerim ; Nam, Kiwoong ; Mo, Heejung ; An, Sang Joon ; Choi, H. Alex ; Yoon, Byung Woo. / Nocturnal desaturation is associated with neurological deterioration following ischemic stroke : A retrospective observational study. In: Journal of Clinical Sleep Medicine. 2017 ; Vol. 13, No. 11. pp. 1273-1279.
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abstract = "Study Objectives: The mechanism of early neurological deterioration (END) in patients with stroke remains unclear. We assessed the relationship between nocturnal oxygen desaturation (NOD) in the stroke unit (SU) and END, especially occurring at nighttime, following acute stroke. Methods: A retrospective analysis was performed on a total of 276 patients with ischemic stroke who were admitted to the SU between July 2013 and June 2015. The oxygen desaturation index was calculated from pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 pm to 7:00 am) after admission, and NOD was defined as oxygen desaturation index ≥ 5 events/h. END was defined as an increase of ≥ 2 points from the baseline National Institutes of Health Stroke Scale during 7 days after onset. We compared clinical characteristics and NOD between patients with and without END. Results: Among the included patients (mean age 69.2; male 55.4{\%}), 42 patients (15.2{\%}) experienced END. The proportion of NOD was significantly greater in the END group (45.2{\%} versus 12.8{\%}, P < .001). After adjusting for confounders, NOD was independently associated with END (odds ratio 7.57; 95{\%} confidence interval 3.14-18.27). Among END patients, 47.6{\%} patients (n = 20) had END during nighttime. Moreover, NOD was more frequent in patients with END during nighttime compared to those with END during daytime (73.7{\%} versus 26.1{\%}, P = .002). Conclusions: NOD in the SU was associated with END, especially during nighttime, after ischemic stroke. This suggests that treatment of sleep-disordered breathing could be a modifiable factor to possibly reduce the risk of neurological worsening among acute stroke patients.",
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T1 - Nocturnal desaturation is associated with neurological deterioration following ischemic stroke

T2 - A retrospective observational study

AU - Kim, Tae Jung

AU - Ko, Sang Bae

AU - Jeong, Han Gil

AU - Kim, Chi Kyung

AU - Kim, Yerim

AU - Nam, Kiwoong

AU - Mo, Heejung

AU - An, Sang Joon

AU - Choi, H. Alex

AU - Yoon, Byung Woo

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Study Objectives: The mechanism of early neurological deterioration (END) in patients with stroke remains unclear. We assessed the relationship between nocturnal oxygen desaturation (NOD) in the stroke unit (SU) and END, especially occurring at nighttime, following acute stroke. Methods: A retrospective analysis was performed on a total of 276 patients with ischemic stroke who were admitted to the SU between July 2013 and June 2015. The oxygen desaturation index was calculated from pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 pm to 7:00 am) after admission, and NOD was defined as oxygen desaturation index ≥ 5 events/h. END was defined as an increase of ≥ 2 points from the baseline National Institutes of Health Stroke Scale during 7 days after onset. We compared clinical characteristics and NOD between patients with and without END. Results: Among the included patients (mean age 69.2; male 55.4%), 42 patients (15.2%) experienced END. The proportion of NOD was significantly greater in the END group (45.2% versus 12.8%, P < .001). After adjusting for confounders, NOD was independently associated with END (odds ratio 7.57; 95% confidence interval 3.14-18.27). Among END patients, 47.6% patients (n = 20) had END during nighttime. Moreover, NOD was more frequent in patients with END during nighttime compared to those with END during daytime (73.7% versus 26.1%, P = .002). Conclusions: NOD in the SU was associated with END, especially during nighttime, after ischemic stroke. This suggests that treatment of sleep-disordered breathing could be a modifiable factor to possibly reduce the risk of neurological worsening among acute stroke patients.

AB - Study Objectives: The mechanism of early neurological deterioration (END) in patients with stroke remains unclear. We assessed the relationship between nocturnal oxygen desaturation (NOD) in the stroke unit (SU) and END, especially occurring at nighttime, following acute stroke. Methods: A retrospective analysis was performed on a total of 276 patients with ischemic stroke who were admitted to the SU between July 2013 and June 2015. The oxygen desaturation index was calculated from pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 pm to 7:00 am) after admission, and NOD was defined as oxygen desaturation index ≥ 5 events/h. END was defined as an increase of ≥ 2 points from the baseline National Institutes of Health Stroke Scale during 7 days after onset. We compared clinical characteristics and NOD between patients with and without END. Results: Among the included patients (mean age 69.2; male 55.4%), 42 patients (15.2%) experienced END. The proportion of NOD was significantly greater in the END group (45.2% versus 12.8%, P < .001). After adjusting for confounders, NOD was independently associated with END (odds ratio 7.57; 95% confidence interval 3.14-18.27). Among END patients, 47.6% patients (n = 20) had END during nighttime. Moreover, NOD was more frequent in patients with END during nighttime compared to those with END during daytime (73.7% versus 26.1%, P = .002). Conclusions: NOD in the SU was associated with END, especially during nighttime, after ischemic stroke. This suggests that treatment of sleep-disordered breathing could be a modifiable factor to possibly reduce the risk of neurological worsening among acute stroke patients.

KW - During nighttime

KW - Early neurological deterioration

KW - Nocturnal desaturation

KW - Sleep-disordered breathing

KW - Stroke unit

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