open access

Vol 56, No 3 (2022)
Research Paper
Submitted: 2022-03-04
Accepted: 2022-04-25
Published online: 2022-05-24
Get Citation

Association between nocturnal oxygen desaturation and ischaemic stroke outcomes

Izabela Wojtasz12, Andrzej Tomski3, Radosław Kaźmierski45
·
Pubmed: 35607842
·
Neurol Neurochir Pol 2022;56(3):267-275.
Affiliations
  1. Department for Neurology with Stroke Unit, L. Bierkowski Hospital, Poznan, Poland;
  2. Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Poland
  3. Institute of Mathematics, University of Silesia, Katowice, Poland
  4. Department of Neurology, Collegium Medicum, University of Zielona Gora, Poland
  5. Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland

open access

Vol 56, No 3 (2022)
Research papers
Submitted: 2022-03-04
Accepted: 2022-04-25
Published online: 2022-05-24

Abstract

Clinical rationale for the study. This study aimed to assess the association between nocturnal hypoxemia and early acute ischaemic stroke (AIS) outcomes in patients without oxygen supplementation.

Material and methods. One hundred and six AIS patients consecutively admitted to the stroke unit were included in this study. Baseline demographic and medical data and arterial blood saturation (SpO2) measurements during night-sleep (from 10pm to 6am) were examined for their association with stroke outcomes, including the National Institutes of Health Stroke Scale (NIHSS) score on the 7th day or differences between the NIHSS score on the 1st day and the 7th day after stroke onset. Measurements of SpO2 were made using a pulse oximeter of the Spacelabs Medical Inc. (USA) monitoring system, and the number of apnoea episodes and their duration were recorded by ECG Holter with respiration monitoring (CardioMem®, Getamed, GE).

Results. The study showed that age (Spearman’s r = 0.207, p = 0.033) and parameters attributable to anaemia (RBC r = –0.205, p = 0.035, Hb r = –0.225, p = 0.02 and HCT r = –0.196, p = 0.044), atrial fibrillation and ischaemic changes in both brain hemispheres (p = 0.023 and 0.01, respectively) were correlated with the study outcomes. In terms of saturation parameters, we demonstrated that the ‘total desaturation burden’ (i.e. [100% minus actual measured SpO2%] x apnoea duration) and multiple apnoeas of longer than 20 seconds were correlated with worse functional outcomes. Measures of shorter desaturation episodes (i.e. SpO2 oxygen desaturation index (ODI) at 3% and 4%, and time-weighted desaturations below the determined thresholds (SpO2 from 95% to 85%) demonstrated non-significant associations with the study outcomes.

Conclusions and clinical implications. This study demonstrated that long-lasting desaturation episodes during the night, depicted by the ‘total desaturation burden’, were correlated with worse functional outcomes in AIS, while measures of shorter desaturation episodes were not correlated. In future clinical trials, indications for oxygen supplementation should include the methodology of personalised medicine and introduce individual approaches based on specially formulated, novel multifactorial algorithms.

Abstract

Clinical rationale for the study. This study aimed to assess the association between nocturnal hypoxemia and early acute ischaemic stroke (AIS) outcomes in patients without oxygen supplementation.

Material and methods. One hundred and six AIS patients consecutively admitted to the stroke unit were included in this study. Baseline demographic and medical data and arterial blood saturation (SpO2) measurements during night-sleep (from 10pm to 6am) were examined for their association with stroke outcomes, including the National Institutes of Health Stroke Scale (NIHSS) score on the 7th day or differences between the NIHSS score on the 1st day and the 7th day after stroke onset. Measurements of SpO2 were made using a pulse oximeter of the Spacelabs Medical Inc. (USA) monitoring system, and the number of apnoea episodes and their duration were recorded by ECG Holter with respiration monitoring (CardioMem®, Getamed, GE).

Results. The study showed that age (Spearman’s r = 0.207, p = 0.033) and parameters attributable to anaemia (RBC r = –0.205, p = 0.035, Hb r = –0.225, p = 0.02 and HCT r = –0.196, p = 0.044), atrial fibrillation and ischaemic changes in both brain hemispheres (p = 0.023 and 0.01, respectively) were correlated with the study outcomes. In terms of saturation parameters, we demonstrated that the ‘total desaturation burden’ (i.e. [100% minus actual measured SpO2%] x apnoea duration) and multiple apnoeas of longer than 20 seconds were correlated with worse functional outcomes. Measures of shorter desaturation episodes (i.e. SpO2 oxygen desaturation index (ODI) at 3% and 4%, and time-weighted desaturations below the determined thresholds (SpO2 from 95% to 85%) demonstrated non-significant associations with the study outcomes.

Conclusions and clinical implications. This study demonstrated that long-lasting desaturation episodes during the night, depicted by the ‘total desaturation burden’, were correlated with worse functional outcomes in AIS, while measures of shorter desaturation episodes were not correlated. In future clinical trials, indications for oxygen supplementation should include the methodology of personalised medicine and introduce individual approaches based on specially formulated, novel multifactorial algorithms.

Get Citation

Keywords

night-sleep, apnoea, oxygenation, hypoxia, SpO2, ischaemic stroke, stroke outcome

About this article
Title

Association between nocturnal oxygen desaturation and ischaemic stroke outcomes

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 56, No 3 (2022)

Article type

Research Paper

Pages

267-275

Published online

2022-05-24

Page views

4496

Article views/downloads

585

DOI

10.5603/PJNNS.a2022.0033

Pubmed

35607842

Bibliographic record

Neurol Neurochir Pol 2022;56(3):267-275.

Keywords

night-sleep
apnoea
oxygenation
hypoxia
SpO2
ischaemic stroke
stroke outcome

Authors

Izabela Wojtasz
Andrzej Tomski
Radosław Kaźmierski

References (36)
  1. Ali K, Warusevitane A, Lally F, et al. The stroke oxygen pilot study: a randomized controlled trial of the effects of routine oxygen supplementation early after acute stroke--effect on key outcomes at six months. PLoS One. 2014; 8(6): e59274.
  2. Silva Y, Puigdemont M, Castellanos M, et al. Semi-intensive monitoring in acute stroke and long-term outcome. Cerebrovasc Dis. 2005; 19(1): 23–30.
  3. Rowat AM, Dennis MS, Wardlaw JM. Hypoxaemia in acute stroke is frequent and worsens outcome. Cerebrovasc Dis. 2006; 21(3): 166–172.
  4. Roffe C, Nevatte T, Sim J, et al. Stroke Oxygen Study Investigators and the Stroke OxygenStudy Collaborative Group. Effect of routine low-dose oxygen supplementation on death and disability in adults with acute stroke: the stroke oxygen study randomized clinical trial. JAMA. 2017; 318(12): 1125–1135.
  5. Aronson LA. Hypoxemia. In: Atlee JL. ed. Complications in Anesthesia. 2nd Edition. Saunders, Philadelphia 2007: 637–640.
  6. Lawrence M. All you really need to know to interpret arterial blood gases 2nd Edition. Lippincott Williams & Wilkins, Philadelphia 1999.
  7. Rowat A, Wardlaw J, Dennis M. Changes in arterial oxygen saturation before and after enteral feeding tube insertion in dysphagic stroke patients. Age Ageing. 2004; 33(1): 42–45.
  8. Andrews PJ, Piper IR, Dearden NM, et al. Secondary insults during intrahospital transport of head-injured patients. Lancet. 1990; 335(8685): 327–330.
  9. Gentile MA, Davies JD. Beside monitoring of pulmonary function. In: Vincent JL, Moore F. ed. Textbook of Critical Care. Elsevier, Philadelphia 2016: 158–166.
  10. Ali K, Cheek E, Sills S, et al. Day-night differences in oxygen saturation and the frequency of desaturations in the first 24 hours in patients with acute stroke. J Stroke Cerebrovasc Dis. 2007; 16(6): 239–244.
  11. Baron JC, Baron JC. Protecting the ischaemic penumbra as an adjunct to thrombectomy for acute stroke. Nat Rev Neurol. 2018; 14(6): 325–337.
  12. Brown DL, Shafie-Khorassani F, Kim S, et al. Do apneas and hypopneas best reflect risk for poor outcomes after stroke? Sleep Med. 2019; 63: 14–17.
  13. Mahmood A, Neilson S, Biswas V, et al. Normobaric oxygen therapy in acute stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2022 [Epub ahead of print]: 1–11.
  14. Rønning OM, Guldvog B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999; 30(10): 2033–2037.
  15. Alfredsson J, James SK, Erlinge D, et al. DETO2X-SWEDEHEART Investigators. Randomized comparison of early supplemental oxygen versus ambient air in patients with confirmed myocardial infarction: Sex-related outcomes from DETO2X-AMI. Am Heart J. 2021; 237: 13–24.
  16. Powers WJ, Rabinstein AA, Ackerson T, et al. American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2018; 49(3): e46–e4e110.
  17. Kobayashi A, Czlonkowska A, Ford GA, et al. European academy of neurology and european stroke organization consensus statement and practical guidance for pre-hospital management of stroke. Eur J Neurol. 2018; 25(3): 425–433.
  18. Błażejewska-Hyżorek B, Czernuszenko A, Członkowska A, et al. Wytyczne postępowania w udarze mózgu. Polski Przegląd Neurologiczny. 2019; 15(A): 1–156.
  19. Nael K, Khan R, Choudhary G, et al. Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundaries. Stroke. 2014; 45(7): 1985–1991.
  20. Wnuk M, Drabik L, Derbisz J, et al. Prognostic significance of age in patients with acute ischaemic stroke treated with intravenous thrombolysis. Neurol Neurochir Pol. 2022; 56(1): 81–88.
  21. Akca O, Nichols J, Stewart B, et al. Association of early oxygenation levels with mortality in acute ischemic stroke - a retrospective cohort study. J Stroke Cerebrovasc Dis. 2020; 29(2): 104556.
  22. Zhang H, Campos I, Chan L, et al. Association of central venous oxygen saturation variability and mortality in hemodialysis patients. Blood Purif. 2019; 47(1-3): 246–253.
  23. Michalak S, Kazmierski R, Hellmann A, et al. Serum paraoxonase/arylesterase activity affects outcome in ischemic stroke patients. Cerebrovasc Dis. 2011; 32(2): 124–132.
  24. Anderson CS, Arima H, Lavados P, et al. HeadPoST Investigators and Coordinators. Cluster-Randomized, crossover trial of head positioning in acute stroke. N Engl J Med. 2017; 376(25): 2437–2447.
  25. Adams HP, Bendixen BH, Kappelle LJ, 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.
  26. Azarbarzin A, Sands SA, Stone KL, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the osteoporotic fractures in men study and the sleep heart health study. Eur Heart J. 2019; 40(14): 1149–1157.
  27. Chen F, Chen K, Zhang C, et al. Evaluating the clinical value of the hypoxia burden index in patients with obstructive sleep apnea. Postgrad Med. 2018; 130(4): 436–441.
  28. Pountain SJ, Roffe C. Does routine oxygen supplementation in patients with acute stroke improve outcome? BMJ. 2012; 345: e6976.
  29. Audebert HJ, Rott MM, Eck T, et al. Systemic inflammatory response depends on initial stroke severity but is attenuated by successful thrombolysis. Stroke. 2004; 35(9): 2128–2133.
  30. Winbeck K, Poppert H, Etgen T, et al. Prognostic relevance of early serial C-reactive protein measurements after first ischemic stroke. Stroke. 2002; 33(10): 2459–2464.
  31. Kazmierski R. Predictors of early mortality in patients with ischemic stroke. Expert Rev Neurother. 2006; 6(9): 1349–1362.
  32. Muir KW, Weir CJ, Alwan W, et al. C-reactive protein and outcome after ischemic stroke. Stroke. 1999; 30(5): 981–985.
  33. Skajaa N, Adelborg K, Horváth-Puhó E, et al. Risks of stroke recurrence and mortality after first and recurrent strokes in denmark. Neurology. 2021; 98(4): e329–e342.
  34. Wańkowicz P, Gołąb-Janowska M, Nowacki P. Risk factors for death by acute ischaemic stroke in patients from West-Pomerania, Poland. Neurol Neurochir Pol. 2020; 54(2): 150–155.
  35. Chalos V, van der Ende NAM, Lingsma HF, et al. MR CLEAN Investigators. National institutes of health stroke scale: an alternative primary outcome measure for trials of acute treatment for ischemic stroke. Stroke. 2020; 51(1): 282–290.
  36. Heitsch L, Ibanez L, Carrera C, et al. International Stroke Genetics Consortium. Early neurological change after ischemic stroke is associated with 90-day outcome. Stroke. 2021; 52(1): 132–141.

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