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Volume 13 No. 11
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Scientific Investigations

Nocturnal Desaturation is Associated With Neurological Deterioration Following Ischemic Stroke: A Retrospective Observational Study

Tae Jung Kim, MD1; Sang-Bae Ko, MD, PhD1; Han-Gil Jeong, MD1; Chi Kyung Kim, MD, PhD2; Yerim Kim, MD3; Kiwoong Nam, MD1; Heejung Mo, MD1; Sang Joon An, MD1; H. Alex Choi4; Byung-Woo Yoon, MD, PhD1
1Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; 2Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea; 3Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea; 4Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute, Memorial Hermann of Texas Medical Center, Houston, Texas

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.

Citation:

Kim TJ, Ko SB, Jeong HG, Kim CK, Kim Y, Nam K, Mo H, An SJ, Choi HA, Yoon BW. Nocturnal desaturation is associated with neurological deterioration following ischemic stroke: a retrospective observational study. J Clin Sleep Med. 2017;13(11):1273–1279.


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