The pathogenic link between sleep-disordered breathing and early neurological deterioration in acute ischaemic stroke patients is now a subject of clinical investigations. Vasomotor reactivity and intracranial blood flow steal in response to changing vasodilatory stimuli like carbon dioxide play a pivotal role in clinical deterioration with reversed Robin Hood syndrome. A mechanical ventilatory correction in selected acute stroke patients might have a beneficial effect on sleep-disordered breathing and brain perfusion. This is a novel therapeutic target and the missing link in the pathogenesis of early neurological deterioration and stroke recurrence.
HosseletJJ, AyappaI, NormanRG, KriegerAC, RapoportDM. Classification of sleepdisordered breathing. Am J Respir Crit Care Med2001; 163:398–405.
2.
BassettiC, AldrichM, ChervinR, QuintD. Sleep apnea in patients with transient ischemic attack and stroke. Neurology1996; 47:1167–73.
3.
YoungT, PeppardP, GottliebD. The epidemiology of obstructive sleep apnoea: a population health perspective. Am J Respir Crit Care Med2002; 165:1217–39.
4.
ArztM, YoungT, FinnL,Association of sleepdisordered breathing and the occurrence of stroke. Am J Respir Crit Care Med2005; 172:1447–51.
5.
YaggiHK, ConcatoJ, KernanWN, LichtmanJH, BrassLM, MohseninV. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med2005; 353:2034–41.
6.
BassettiCL, MilanovaM, GuggerM. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke2006; 37:967–72.
7.
IranzoA, SantamaríaJ, BerenguerJ, SánchezM, ChamorroA. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction. Neurology2002; 58:911–6.
8.
GrottaJC, WelchKM, FaganSC,Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial. Stroke2001; 32:661–8.
9.
DvalosA, ToniD, IweinsF, LesaffreE, BastianelloS, CastilloJ. Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European Cooperative Acute Stroke Study (ECASS) I. Stroke. 1999; 30:2631–6.
10.
AlexandrovAV, GrottaJC. Arterial re-occlusion in stroke patients treated with intravenous tissue plasminogen activator. Neurology2002; 59:862–7.
11.
ShamsuzzamanAS, GershBJ, SomersVK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA2003; 290:1906–14.
12.
WolkR, KaraT, SomersVK. Sleep-disordered breathing and cardiovascular disease. Circulation2003; 108:9–12.
13.
BeckerH, BradenburgU, PeterJH,Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure. Am J Respir Crit Care Med1995; 151:215–8.
14.
RingelsteinEB, SieversC, EckerS, SchneiderPA, OtisSM. Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions. Stroke1988; 19:963–9.
15.
NasrN, Pavy-Le TraonA, CzosnykaM, TibergeM, SchmidtE, LarrueV. Cerebral autoregulation in patients with obstructive sleep apnea syndrome during wakefulness. Eur J Neurol2009; 16:386–91.
16.
AlexandrovAV, NguyenHT, RubieraM,Prevalence and risk factors associated with reversed Robin Hood syndrome in acute ischemic stroke. Stroke2009; 40:2738–42.
17.
MarkusHS, HarrisonMJ. Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke1992; 23:668–73.
18.
SilvestriniM, VernieriF, PasqualettiP,Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis. JAMA2000; 283:2122–7.
19.
FurtnerM, StaudacherM, FrauscherB,Cerebral vasoreactivity decreases overnight in severe obstructive sleep apnea syndrome: a study of cerebral hemodynamics. Sleep Med2009; 10:875–81.
20.
IpMS, LamB, ChanLY,Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous airway pressure. Am J Respir Crit Care Med2000; 162:2166–71.
21.
PhillipsRA, NarkiewiczK, PesekCA, HaynesWG, DykenME, SomersVK. Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens1999; 17:61–6.
22.
PalazzoP, BalucaniC, BarlinnK,Association of reversed Robin Hood syndrome with risk of stroke recurrence. Neurology2010; 75:2003–8.
