脳卒中による脳幹損傷患者において睡眠時無呼吸は多く認められる（Abstract: 52）

脳卒中による脳幹の損傷は睡眠時無呼吸の存在および重症度に影響する
Stroke damage to brainstem associated with presence and severity of sleep apnea
脳卒中により脳幹を損傷した患者は脳の他部位が損傷された患者よりも睡眠時無呼吸の有病率が高いとの研究結果が2014年American Stroke Association's International Stroke Conferenceで発表された。スタディに参加した虚血性脳卒中患者355人（平均年齢65歳、男性55%）は、既に登録されていたBrain Attack Surveillance in Corpus Christi（BASIC）プロジェクトから抽出された。スタディ対象の59%がヒスパニック系であり、非ヒスパニック系白人が35%、アメリカ先住民が1%、アフリカ系米国人が4%であった。参加者は脳卒中から13日後に携帯用呼吸モニターを用いた睡眠時無呼吸のスクリーニングを受けた。神経科医が脳のCTおよびMRI画像を読影し、脳幹病変を有しているかを判断した。355人の脳卒中患者のうち11%が脳幹傷害を有し、84%が睡眠時無呼吸を有していた。脳幹に病変のない者において、睡眠時無呼吸を有するのは59%であった。今回のスタディは、脳卒中後患者において脳損傷部位と睡眠時無呼吸との関連に関する地域住民を対象としたこれまでで最も大規模なものである。
Full Text

People whose brainstems are affected by their stroke have a significantly higher prevalence of sleep apnea than those who have stroke-related injury elsewhere in the brain, according to research presented at the American Stroke Association's International Stroke Conference 2014.

Sleep apnea is marked by interrupted breathing during sleep and can lead to serious health problems including heart disease and stroke.

"This is the largest population-based study to address the issue of the location of the brain injury and its relationship to sleep apnea in post-stroke patients," said Devin L. Brown, M.D., M.S., lead author of the study and associate professor of neurology and associate director of the stroke program at the University of Michigan in Ann Arbor.

The 355 ischemic stroke patients, average 65 years and 55 percent men, who participated in the study, were drawn from those already enrolled in the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Hispanics represented 59 percent of the study group; Non-Hispanic whites 35 percent; Native Americans 1 percent; and African-Americans 4 percent.

According to researchers, patients were also offered sleep apnea screening with a portable respiratory monitor and were screened about 13 days after a stroke.

Neurologists interpreted CT and MRI brain imaging scan results to determine if patients had brainstem involvement or no brainstem involvement.

Of the 11 percent of 355 stroke patients with brainstem injury, 84 percent had sleep apnea. Of those without brainstem involvement, 59 percent had sleep apnea.

"While these numbers are high, more research into the relationship between stroke and sleep apnea is needed before we recommend routine sleep apnea screening in post-stroke patients," Brown said.

In the future, Brown said her group will continue to explore the relationship between sleep apnea and stroke.

Co-authors are Mollie McDermott, M.D.; Ashkan Mowia, M.D.; Ronald Chervin, M.D., M.S; Lewis Morgenstern, M.D.; Kevin Kerber, M.D.; Garnett Hegeman III, RPSGT; Melinda Smith, Dr.PH.; Nelda Garcia, B.S.; and Lynda Lisabeth, Ph.D.

The National Institutes of Health funded the study.