Sleep Disorders and Stroke

Snoring occurs when air being inhaled and exhaled through a crowded airway creates noise as a result of friction. For some people, snoring is soft and infrequent, but for many, it’s very loud and constant suggesting a high degree of resistance in the upper airways.

Sleep disorders have been known to exist for centuries but most of the advanced research in them has happened in the last few decades only. Loud snoring is a common presenting complaint. Snoring occurs when air being inhaled and exhaled through a crowded airway creates noise as a result of friction. For some people, snoring is soft and infrequent, but for many, it’s very loud and constant suggesting a high degree of resistance in the upper airways. Snoring alone may be inconsequential but when associated with a disturbed sleep, frequent awakening during sleep, dry throat on waking up, morning headache, heavy headedness during the day, tendency to take short naps during the day, falling asleep during meetings, feeling exhausted most of the time, could be suggestive of Obstructive Sleep Apnea or OSA as it is popularly called. 

As the name suggests, the basic mechanism behind OSA is an obstruction of the upper airway during sleep. This could be due to bulky tongue or uvula, micrognathia, large tonsils, floppy muscles of the throat blocking the passage of air. During this period of obstruction which happens multiple times during the night, an individual develops apnea (cessation of breathing) and hypopneas (diminished breathing) which is associated with a decrease in oxygen levels in the blood which then results in hypoxic damage to the various organs of the body including brain, heart, kidneys etc by triggering off an inflammatory cascade. Unfortunately, because the symptoms are nonspecific, OSA is often underdiagnosed. Apart from OSA there are other disorders also which result in decreased oxygenation in the body during sleep and are collectively called the Sleep related Breathing Disorders (SRBD). 

Obesity, Male gender and advancing age are important and common risk factors for the development of both these diseases. Objective testing is required for the diagnosis of OSA after Stroke, as the classical symptoms may not be present. The gold standard for diagnosis of OSA is formal polysomnography or a sleep study conducted in a hospital-based sleep laboratory, but high-quality portable sleep studies done at home could also be conducted. There are certain questionnaires also that could be used as initial screening tool.

The only preventive measure can be early detection of OSA and its appropriate treatment. What is most scary is that many patients develop paralytic stroke while they are sleeping and are discovered only the next morning when precious time has been lost and any intervention is unlikely to yield any definite improvement. Thus, if anyone suffers from any of these – Snoring, episodes of choking spells at night, excessive daytime sleepiness, uncontrolled blood pressure or blood sugar, abnormalities of heart rate, then they must contact a sleep specialist for timely evaluation and treatment.