With Sleep Apnea
By Deirdre Stewart, RN, PhD
Sleep apnea is common in stroke
survivors. Recent studies suggest that as many as 65% of
stroke sufferers experience some degree of sleep apnea.
According to a leading researcher and physician in the
field of sleep-disordered breathing, Mark E. Dyken, MD,
University of Iowa, this high rate of sleep apnea in
stroke survivors “requires aggressive assessment.”
Because data suggest that rehabilitation outcomes may be
worse in stroke sufferers who have sleep apnea, it is of
particular importance to identify it.
Overview of sleep apnea
Normally during sleep the muscles which control the
tongue and soft palate hold the airway open. As these
muscles relax, the airway becomes narrower, which can
cause snoring and breathing difficulties. In some cases,
these muscles relax too much, which causes the airway to
become completely blocked, preventing any airflow. Once
the airway has closed and no breathing is occurring
(apnea), the brain realizes that there is a lack of
oxygen and alerts the body to wake up. Though the
sufferer is often not aware of it, this cycle can occur
several hundreds of times each night, severely
disrupting sleep. This is sleep apnea.
The impact of sleep apnea on health
Each time an apnea ends, there is a surge in heart rate
and blood pressure. These changes, as well as drops in
oxygen levels that result from sleep apnea, have been
identified in the progression of high blood pressure,
heart disease, congestive heart failure, transient
ischemic attacks (TIAs), and stroke.
Treating sleep apnea
Sleep apnea is commonly treated with positive airway
pressure (PAP). PAP is administered via a nasal mask
that is connected to a flow generator, or blower. The
flow generator delivers a lightly pressurized stream of
air that supports the muscles in the throat during
sleep. There are many types of flow generators, but for
stroke survivors with sleep apnea, the best type of PAP
is automatic. Automatic positive airway pressure devices
adjust the strength of air that they blow throughout the
night, to provide the least amount of air necessary to
support the airway breath by breath. In a sense,
automatic PAP devices provide customized treatment based
on the individual needs of each unique patient.
Caring for stroke survivors with sleep apnea
For stroke survivors, this customized treatment is
especially important. Stroke can affect the severity of
sleep apnea, and as stroke survivors recover, the amount
of airway pressure required to treat them may change.
Automatic PAP will adjust to meet those changes.
Additionally, most patients find automatic PAP more
comfortable than other types of treatment. In the stroke