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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(11): 785-788
DOI: 10.1590/0004-282X20170137
Article

The critical influence of nocturnal breathing complaints on the quality of sleep after stroke: the Pittsburgh Sleep Quality Index and STOP-BANG

A influência crítica das queixas respiratórias noturnas na qualidade final do sono após acidente vascular cerebral: índice de qualidade de sono de Pittsburgh e STOP-BANG
Giuliano da Paz Oliveira
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
,
Eliana Regina Lottemberg Vago
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
2   Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brasil
,
Gilmar Fernandes do Prado
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
,
Fernando Morgadinho Santos Coelho
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
2   Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brasil
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ABSTRACT

In stroke patients particularly, many factors, such as sleep-related respiratory disturbances, can impair sleep. Cheap and easy-to-use tools have been created to identify sleep quality and sleep disturbances in patients after stroke. This study described the scores of the sleep apnea screening questionnaire - STOP-BANG - in patients after a stroke, and correlated the findings with sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). The scores of the STOP-BANG and PSQI were 4.3 ± 1.8 and 76 ± 3.9, respectively. The STOP-BANG scores were higher in poor sleepers (4.5 ± 1.6 versus 3.5 ± 1.9; p = 0.032). Logistic regression analysis was used to identify predictors of subjective sleep quality (PSQI) and the STOP-BANG as a predictor of poor quality sleep, with a relative risk of 1.6, controlled for age and sex. This study indicated that sleep quality was largely influenced by sleep breathing problems, which were well identified by the STOP-BANG, especially in younger stroke patients.

RESUMO

Especialmente em pacientes com acidente vascular cerebral (AVC), muitos fatores prejudicam o sono, como distúrbios respiratórios do sono (DRS). Ferramentas mais baratas foram usadas para identificar a qualidade do sono e distúrbios do sono após AVC. Este estudo verificou a influência das queixas DRS na qualidade do sono após AVC utilizando questionários. Nós investigamos a qualidade do sono eo risco de Apneia Obstrutiva do Sono com o Índice de Qualidade do Sono de Pittsburgh (PSQI) e Stop-Bang em 68 pacientes após AVC. As pontuações de STOP-BANG e PSQI foram de 4,3 ± 1,8 e 7,6 ± 3,9, respectivamente. As pontuações de STOP-BANG foram mais elevadas em pacientes com sono ruim (4,5 ± 1,6 versus 3,5 ± 1,9; p = 0,032). A regressão logística caracterizou o STOP-BANG como preditor de um sono de má qualidade. Estes achados confirmam a influência das queixas respiratórias noturnas na qualidade do sono após AVC.

Keywords:

stroke - sleep - surveys and questionnaires

Palavras-chave:

acidente vascular cerebral - sono - inquéritos e questionários


Publication History

Received: 28 March 2017

Accepted: 08 August 2017

Article published online:
01 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Coca A, Messerli FH, Benetos A, Zhou Q, Champion A, Cooper-DeHoff RM et al. Predicting stroke risk in hypertensive patients with coronary artery disease: a report from the INVEST. Stroke. 2008;39(2):343-8. https://doi.org/10.1161/STROKEAHA.107.495465
  • 2 Da Rocha PC, Barroso MT, Dantas AA, Melo LP, Campos TF. Predictive factors of subjective sleep quality and insomnia complaint in patients with stroke: implications for clinical practice. An Acad Bras Cienc. 2013;85(3):1 197-206. https://doi.org/10.1590/S0001-37652013005000053
  • 3 Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil. 2014;95(5):986-95.e1. https://doi.org/10.1016/j.apmr.2013.10.032
  • 4 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034-41. https://doi.org/10.1056/NEJMoa043104
  • 5 St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M et al. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation. 2016;134(18):e367-86. https://doi.org/10.1161/CIR.20170137201701370444
  • 6 Mohsenin V, Culebras A. Sleep-related breathing disorders and risk of stroke. Stroke. 2001;32(6):1271-8. https://doi.org/10.1161/01.STR.32.6.1271
  • 7 Pasic Z, Smajlovic D, Dostovic Z, Kojic B, Selmanovic S. Incidence and types of sleep disorders in patients with stroke. Med Arh. 2011;65(4):225-7. https://doi.org/10.5455/medarh.2011.65.225-227
  • 8 Suh M, Choi-Kwon S, Kim JS. Sleep disturbances after cerebral infarction: role of depression and fatigue. J Stroke Cerebrovasc Dis. 2014;23(7):1949-55. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.029
  • 9 Hermann DM, Siccoli M, Brugger P, Wachter K, Mathis J, Achermann P et al. Evolution of neurological, neuropsychological and sleep-wake disturbances after paramedian thalamic stroke. Stroke. 2008;39(1):62-8. https://doi.org/10.1161/STROKEAHA.107.494955
  • 10 Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39. https://doi.org/10.1164/rccm.2109080
  • 11 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-5. https://doi.org/10.1056/NEJM199304293281704
  • 12 Hermann DM, Bassetti CL. Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology. 2016;87(13):1407-16. https://doi.org/10.1212/WNL.20170137201701373037
  • 13 Wright KP Jr, Hull JT, Hughes RJ, Ronda JM, Czeisler CA. Sleep and wakefulness out of phase with internal biological time impairs learning in humans. J Cogn Neurosci. 2006;18(4):508-21. https://doi.org/10.1162/jocn.2006.18.4.508
  • 14 Marti-Soler H, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Preisig M et al. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med. 2016;4(9):742-8. https://doi.org/10.1016/S2213-2600(16)30075-3
  • 15 Coelho FM, Pradella-Hallinan M, Palombini L, Tufik S, Bittencourt LR. The STOP-BANG questionnaire was a useful tool to identify OSA during epidemiological study in São Paulo (Brazil). Sleep Med. 2012;13(4):450-1. https://doi.org/10.1016Zj.sleep.2012.01.008
  • 16 Kojic B, Burina A, Sinanovic O. One year outcome of acute stroke patients with sleep apnea. Med Arch. 2015;69(3):149-52. https://doi.org/10.5455/medarh.2015.69.149-152
  • 17 Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria: history, rationale, description, and significance. Sleep Med. 2014;15(8):860-73. https://doi.org/10.1016/j.sleep.2014.03.025
  • 18 Caneda MA, Fernandes JG, de Almeida AG, Mugnol FE. [Reliability of neurological assessment scales in patients with stroke]. Arq Neuropsiquiatr. 2006;64(3A):690-7. Portuguese. https://doi.org/10.1590/S0004-282X2006000400034
  • 19 Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41. https://doi.org/10.1161/01.STR.241.35
  • 20 Cincura C, Pontes-Neto OM, Neville IS, Mendes HF, Menezes DF, Mariano DC et al. Validation of the National Institutes of Health Stroke Scale, modified Rankin Scale and Barthel Index in Brazil: the role of cultural adaptation and structured interviewing. Cerebrovasc Dis. 2009;27(2):1 19-22. https://doi.org/10.1159/000177918
  • 21 Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP Jr et al. The Sleep Disorders Questionnaire. I: creation and multivariate structure of SDQ. Sleep. 1994;17(2): 160-7. https://doi.org/10.1093/sleep/172.160
  • 22 Reis R, Teixeira F, Martins V, Sousa L, Batata L, Santos C et al. Validation of a Portuguese version of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea: analysis in a sleep clinic. Rev Port Pneumol (2006). 2015;21(2):61-8. https://doi.org/10.1016/j.rppnen.2014.04.009
  • 23 Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  • 24 Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, de Barba ME et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70-5. https://doi.org/10.1016/j.sleep.2010.04.020
  • 25 Wells RD, Day RC, Carney RM, Freedland KE, Duntley SP. Depression predicts self-reported sleep quality in patients with obstructive sleep apnea. Psychosom Med. 2004;66(5):692-7. https://doi.org/10.1097/01.psy.0000140002.84288.e1
  • 26 Boynton G, Vahabzadeh A, Hammoud S, Ruzicka DL, Chervin RD. Validation of the STOP-BANG Questionnaire among patients referred for suspected obstructive sleep apnea. J Sleep Disord Treat Care. 2013;2(4). https://doi.org/10.4172/2325-9639.1000121
  • 27 Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812-21. https://doi.org/10.1097/ALN.0b013e31816d83e4
  • 28 Chung F, Subramanyam R, Liao P Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108(5):768-75. https://doi.org/10.1093/bja/aes022
  • 29 Westerlund A, Lagerros YT, Kecklund G, Axelsson J, Âkerstedt T. Relationships Between Questionnaire Ratings of Sleep Quality and Polysomnography in Healthy Adults. Behav Sleep Med. 2016;14(2):185-99. https://doi.org/10.1080/15402002.2014.974181