Comprehensive Assessment of the Respiratory Support Effectiveness in Obstructive Sleep Apnea Syndrome in Patients in the Acute Period of Ischemic Stroke
Authors: Bilas Oleh , Titov Ivan 
Published: November 2024

Brain damage due to ischemic stroke and accompanying obstructive sleep apnea syndrome (OSAS) negatively affect the current and long-term results of treatment. The key pathophysiological factors of the negative impact of OSAS are the numerous episodes of systemic and cerebral hypoxemia, hypercapnia, inducing variability of glycemia, blood pressure, and heart rate.
The objective: to analyze the dynamics of changes in ventilation, oxygenation, the variability of blood glucose, cerebral oximetry, and the level of neuron-specific enolase (NSE) in the blood on the background of the use of continuous positive airway pressure (CPAP therapy) in patients with ischemic stroke and concomitant OSAS.
Materials and methods. Two groups of 30 persons each were formed from 60 patients with ischemic stroke and OSAS. Patients of the I group have received basic stroke treatment. For patients of the II group the basic scheme of therapy was supplemented with CPAP. To monitor the effectiveness of CPAP therapy we used “SomnoChek micro” (Weinmann, Germany), “Masimo Root” (Masimo, USA), the Guardian™ Connect System glucose monitoring system (Medtronic, Ireland), capnometry with the “Prizm 7S” monitor (Heaco Ltd., South Korea).
Results. The leading indicator of the severity of OSAS – apnea/hypopnea index before the start of treatment in patients of the I group was 51.21±9.87/h and 51.38±9.93/h in patients of the II group, at the end of the 7th day of treatment – 46.73±9.65/h and 5.54±0.96/h, respectively, at the end of the 14th day – 39.95±9.92/h and 5.28±1.02/h, respectively. The initial average level of carbon dioxide in patients of the I and II groups was 42.30±4.12 mm Hg and 42.80±3.91 mm Hg, respectively, at the end of the 7th day – 41.07±2.92 mm Hg and 37.57±1.67 mm Hg, respectively, and on the 14th day – 38.87±2.41 mm Hg and 36.23±1.57 mm Hg, respectively. The initial average values of cerebral oximetry in patients of the I and II groups were 49.27±4.98% and 50.60±5.40%, respectively, after 3 days of treatment – 50.13±6.61% and 56.87±5 .39%, respectively, at the end of the 7th day – 57.03±7.01% and 67.64±3.02%, respectively. The initial median values of the NSE level in patients of the I and II groups were 31.17 [28.54–38.41] ng/ml and 32.65 [28.71–43.65] ng/ml, respectively, on the 7th day treatment – 26.44 [24.15–33.44] ng/ml and 19.47 [17.46–21.15] ng/ml, respectively, on the 14th day – 24.09 [22.36–28.48] ng/ml and 14.28 [12.49–16.22] ng/ml, respectively. The coefficient of variation of glucose was 17.1% [15.4–18.9] in patients of the I group and 16.2% [14.6–18.1] in the patients of the II group, on the 3rd day – 16.25 [ 14.5–17.8]% and 11.9 [9.5–13.5]%, respectively, on the 5th day – 16.0 [14.2–17.2]% and 7.95 [6.6–9.5]%, respectively, and on the 7th day of treatment – 15.3 [13.5–17.2]% and 8.5 [7.5–8.9]%, respectively.
Conclusions. The use of CPAP therapy in patients with stroke and concomitant OSAS have provided positive dynamics, restoration of adequate ventilation and oxygenation, normalization of the cerebral oximetry index, reduction of NSE level and glucose variability.