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This article is part of the Research Topic

Obstructive Sleep Apnea and The Brain

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Front. Surg. | doi: 10.3389/fsurg.2018.00009

Post stroke sleep disordered breathing – Pathophysiology and Therapy Options

 David Stevens1,  Rodrigo T. Martins2, Sutapa Mukherjee1, 3 and  Andrew Vakulin1, 4*
  • 1Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Australia
  • 2Neuroscience Research Australia (NeuRA), Australia
  • 3Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network (SALHN), Australia
  • 4The NHMRC Centre of Research Excellence, NEUROSLEEP, Woolcock Institute of Medical Research, Australia

Sleep disordered breathing, encompassing both obstructive and central sleep apnea, is prevalent in at least 50% of stroke patients. Small studies have shown vast improvements in post-stroke functional recovery outcomes after treatment of sleep disordered breathing by continuous positive airway pressure. However, compliance to this therapy is very poor in this complex patient group. There are alternative therapy options for sleep disordered breathing that may be more amenable for use in at least some post-stroke patients, including mandibular advancement, supine avoidance and oxygen therapy. However there are few studies which demonstrate efficacy and compliance with these alternative therapies currently. Furthermore novel sleep disordered breathing phenotyping approaches may help to provide important clinical information to direct therapy selection in individual patients. Prior to realising individualised therapy we need a better understanding of the pathophysiology of sleep disordered breathing in post-stroke patients, including the role of inherent phenotypic traits, as well as the contribution of stroke size and location. This review summarises the available literature on sleep disordered breathing pathophysiology and treatment in post-stroke patients, identifies gaps in the literature and sets out areas for further research.

Keywords: Stroke, Hypopnea, Treatment, phenotyping, Sleep apnoea

Received: 02 Dec 2017; Accepted: 01 Feb 2018.

Edited by:

Haralampos Gouveris, Universitätsmedizin der Johannes Gutenberg, Universität Mainz, Germany

Reviewed by:

Nikolaus E. Wolter, Hospital for Sick Children, Canada
Boguslaw Mikaszewski, Gdańsk Medical University, Poland  

Copyright: © 2018 Stevens, Martins, Mukherjee and Vakulin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Andrew Vakulin, Flinders University, Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Adelaide, SA, Australia,