Effet de l’apnée du sommeil sur le risque de chute à 6 mois post-AVC : une étude de cohorte rétro-prospective

Overview & Synopsis

Stroke is the leading cause of disability worldwide. Approximately a quarter of stroke survivors are unable to walk independently three months after stroke and the fall risk is high with a prevalence ranging from 14% to 65% while in the hospital and up to 73% in the first 6 months after discharge with negative consequences on functional recovery and quality of life. Therefore, preventing falls and improving post-stroke balance and stability are crucial. In addition to the classic determinants of post-stroke fall risk, a factor still unknow is the presence of sleep wake-disorders, including sleep apnea (SA). The aim is explore the association between SA and the risk of falls after a stroke. Patients with stroke and screening for sleep disordered breathing by polysomnography were included. The stroke characteristics, sleep information and polysomnographic data were completed in Multimorbidity Apnea Respiratory failure Sleep (MARS) database, designed and developed by the HP2 laboratory (Grenoble, France). Falls incidence and functional assessment were performed in the year after their stroke during consultation with Specialist of Physical and Rehabilitation Medicine. To identify the effect of sleep apnea on the risk of falls at 6 months after a stroke, a univariate model and a multivariable logistic regression model were performed. 145 patients were included, the median age was 63 years [54 ; 70], with a male predominance (67.6%). The median National Institutes of Health Stroke Scale (NIHSS) scores was 4 [3;10]. The prevalence of moderate to severe sleep apnea was 53,1% (77/145). Falls were reported in 26/145 patients (17.9%). Analysis show that the patients with moderate to severe SA had a significant higher fall risk (1.6 [1.02;2.51]) compared to those without or with mild SA. This study confirms the association between sleep apnea and increased risk of falling among stroke survivors. Integrating sleep apnea management into stroke rehabilitation programs may improve reduce the burden of falls on survivors.