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

Giuliano da Paz Oliveira; Eliana Regina Lottemberg Vago; Gilmar Fernandes do Prado; Fernando Morgadinho Santos Coelho

doi:10.1590/0004-282X20170137

Arquivos de Neuro-Psiquiatria, Table of Contents

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

¹Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil

,

Eliana Regina Lottemberg Vago

¹Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil

²Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brasil

,

Gilmar Fernandes do Prado

¹Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil

,

Fernando Morgadinho Santos Coelho

¹Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil

²Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brasil

› Author Affiliations

Abstract

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

Full Text

References

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