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Caring For A Stroke Survivor
With Sleep Apnea

By Deirdre Stewart, RN, PhD

(Page (1 of 2)
 

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 population, comfort is a key factor of success.

 

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