Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up.

BACKGROUND: Sleep apnea occurs frequently among patients with stroke, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality. We aimed to investigate whether obstructive or central sleep apnea was related to reduced long-term survival among patients with stroke. METHODS: Of 151 patients admitted for in-hospital stroke rehabilitation in the catchment area of Umeå from April 1, 1995, to May 1, 1997, 132 underwent overnight sleep apnea recordings at a mean (SD) of 23 (8) days after the onset of stroke. All patients were followed up prospectively for a mean (SD) of 10.0 (0.6) years, with death as the primary outcome; no one was lost to follow-up. Obstructive sleep apnea was defined when the obstructive apnea-hypopnea index was 15 or greater, and central sleep apnea was defined when the central apnea-hypopnea index was 15 or greater. Patients with obstructive and central apnea-hypopnea indexes of less than 15 served as control subjects. RESULTS: Of 132 enrolled patients, 116 had died at follow-up. The risk of death was higher among the 23 patients with obstructive sleep apnea than controls (adjusted hazard ratio, 1.76; 95% confidence interval, 1.05-2.95; P = .03), independent of age, sex, body mass index, smoking, hypertension, diabetes mellitus, atrial fibrillation, Mini-Mental State Examination score, and Barthel index of activities of daily living. There was no difference in mortality between the 28 patients with central sleep apnea and controls (adjusted hazard ratio, 1.07; 95% confidence interval, 0.65-1.76; P = .80). CONCLUSIONS: Patients with stroke and obstructive sleep apnea have an increased risk of early death. Central sleep apnea was not related to early death among the present patients.

Symptom profile of delirium in older people with and without dementia.

Clinical profiles of delirium in 717 older people with and without dementia age 75 years and older in 4 different types of care were studied. Delirium and dementia were diagnosed according to DSM-IV criteria. Delirious demented participants (n = 135) had more often had previous delirium episodes and were more often being treated with analgesics compared to delirious participants without dementia (n = 180). The clinical profile of delirium in the participants with dementia was more frequently characterized by aggressivity, latency in reaction to verbal stimuli, restlessness and agitation, delusions, anxiousness, hallucinations, and a poorer orientation and recognition. Delirium among demented participants more often had a fluctuating course during the day and was more common in the evening and at night. In conclusion, clinical profiles of delirium in participants with and without dementia are different, which might indicate a different etiology or pathophysiology, or both, and a need for different treatment strategies.