Samenvatting

SLEEP APNEA IN STROKE: DIAGNOSIS, CONSEQUENCES & TREATMENT

J.A. AARONSON, C.A.M. VAN BENNEKOM, W.F. HOFMAN & B.A. SCHMAND

Sleep apnea is a common sleep disorder in stroke patients characterized by repetitive cessations of breathing during sleep. In stroke patients, sleep apnea is often left unrecognized and untreated. The first aim of our study was to evaluate a stepped-diagnostic approach, including a prediction model and nocturnal oximetry, to improve early recognition of sleep apnea during rehabilitation. The second aim was to investigate the effect of sleep apnea and its treatment with continuous positive airway pressure (CPAP) in stroke patients. First, we found that stroke patients with sleep apnea were significantly more impaired on both cognitive and functional status than patients without sleep apnea. Second, CPAP treatment improved cognitive functioning of patients in the domains of attention and executive functioning, while it did not improve the functional status.

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Slaapapneu is na slapeloosheid de meest voorkomende slaapstoornis en komt bij tien procent van de mensen voor. Wie aan deze stoornis lijdt, ademt herhaaldelijk niet tijdens zijn of haar slaap. Slaapapneu kan leiden tot niet uitgerust wakker worden, overmatige slaperigheid overdag, hoofdpijn, prikkelbaarheid, somberheid en klachten van geheugen- en concentratieverlies. Justine Aaronson en collega’s gaan in op de diagnose, gevolgen en behandeling bij patiënten die een beroerte hebben gehad.

Slaapapneu is een slaapstoornis waarbij er sprake is van het herhaald optreden van ademstilstanden tijdens de slaap. Deze ademstilstanden worden ook wel apneus genoemd. Slaapapneu gaat gepaard met zuurstofdalingen in het bloed, wat tot een tijdelijk zuurstoftekort en verhoogd koolstofdioxidegehalte leidt. Er zijn diverse vormen van slaapapneu met verschillende oorzaken. De meest voorkomende vorm is obstructief slaapapneu (OSA), waarbij de apneus worden veroorzaakt door een afsluiting van de luchtweg. Een andere vorm is centraal slaapapneu (CSA). Bij CSA wordt vanuit de hersenen geen prikkel gegeven aan de ademhalingspieren. Ook is een combinatie van beide vormen mogelijk. De ernst van de slaapapneu wordt bepaald door het aantal apneus en gedeeltelijke ademstops (hypopneus) per uur slaap (apneuhypopneu index; AHI), waarbij een onderscheid gemaakt wordt tussen lichte (≥5), matige (≥15) en ernstige slaap apneu (≥30). In dit artikel, dat zich focust op apneu bij patiënten met een beroerte, zal de overkoepelende term ‘slaapapneu’ worden gebruikt voor alle vormen van matige tot ernstige slaapapneu.…

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