Stroke - Sleep Disorders, Dysfunction of the Autonomic Nervous System and Depression

Study Overview
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Brief Summary
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The purpose of this study is to investigate sleep disordered breathing, autonomic dysfunction, and post stroke depression in acute and chronic stroke patients. Furthermore, to explore the interaction between these comorbidities, and their relation to stroke aetiology.

Detailed Description
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Up to fifty percent of stroke patients suffer less noticeable comorbidities after the acute phase of a stroke and often the rest of their life. It concerns sleep disordered breathing (SDB), post stroke depression (PSD), and dysfunction of the autonomic nervous system. These comorbidities are seldom recognized, but are associated with a poorer outcome after stroke, reduced quality of life as well as an increased risk of new vascular events. Little is known about the course of the comorbidities, the relationship between the mentioned diseases or which patients are more commonly affected. The investigators will investigate the following hypotheses, and assess the results compared to the stroke aetiology: Stroke patients with SDB have an impaired autonomic function Stroke patients with SDB have an increased risk of PSD Stroke patients with autonomic dysfunction have an increased risk of PSD The investigators will examine stroke patients for signs of sleep disordered breathing, autonomic dysfunction and depression, both in the acute phase (days), in the chronic phase (months) and the very chronic state (years). Thereby the investigators can map the comorbidities course over time. At the same time the patients will be tested for peripheral small and large artery disease as well as MRI will be used to investigate sign of cerebral small vessel disease. Based on power calculations 335 individuals will be enrolled in order to satisfy the project requirements.

Official Title
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Stroke - Sleep Disorders, Dysfunction of the Autonomic Nervous System and Depression

Conditions
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Stroke

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Clinical stroke either ischaemic or haemorrhagic Exclusion Criteria: Transitory ischemic attac Congenital or acquired brain disease, other than stroke Dementia Mental retardation Fatal stroke or severe comorbidities with short expected life Pregnancy or breastfeeding Altered consciousness e.g. delirium or status epilepticus Other cause of the patient, according to the investigator believes, can not complete the study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Acute stroke<br>No interventions. Only tests for depression, sleepapnea and autonomic dysfunction. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sleep disordered breathing at any time after stroke. | The test for sleep disordered breathing will be performed within 7 days from stroke onset and after 6 month and five years. Mild sleep apnea if AHI between 5 and 15, moderate sleep apnea if AHI between 15 and 30 and severe sleep apnea if AHI above 30. Subdivided into obstructive, central or mixed. | six month after stroke | 
| Autonomic dysfunction at any time after stroke. | The test for autonomic dysfunction will be performed within 7 days from stroke onset and after 6 month and five years. Abnormal result of the valsalva manoeuvre, deep breathing, active standing or tilt table test. Improvement or worsening of the parameters like HRV, BRS and CO during the study period. | six month after the stroke | 
| Depression at any time after stroke | The test for depression will be performed within 7 days from stroke onset and after 6 month and five years. Mild, moderate or severe depression according to HAM-D6, MDI or HADS | six month after the stroke | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Peripheral artery disease at any time after stroke | The tests will be performed within 7 days from stroke onset and after 6 month and five years. Stenosis of the carotid artery, abnormal ankle-brachial index or endothelial dysfunction. | six month after the stroke | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sleep apnea syndromes, Autonomic nervous system +/- disease, Depression, Peripheral arterial disease