Monitoring of glucose variability in patients with ishemic stroke and concomitant obstructive sleep apnoea syndrome

Abstract

Introduction. This work is devoted to the study of the dynamics of changes in the variability and average daily values of glucose in patients during the acute period of ischemic stroke and the accompanying syndrome of obstructive sleep apnea (OSAS). Aim. To study the dynamics of changes in average daily values and variability of glucose in patients during the acute period of ischemic stroke with the concomitant obstructive sleep apnea syndrome against the background of non-invasive respiratory support. Materials and methods. There were observed 60 patients with a verified ischemic stroke (1–13 points according to NIHSS), who were performed somnological examinations during the first day of the stroke and confirmed OSAS, which required respiratory correction. Patients were divided into two groups. Group I patients who for various reasons refused to use respiratory support, continued basic treatment according to the current clinical protocol. For patients of the group II, the basic treatment was supplemented with respiratory support. Indices of average daily glucose level, glucose variability (GV) and TIR% index (Time In Range % – time interval of the day in % when the glucose value was within the target range) were determined using the Guardian™ Connect System – continuous glucose monitoring system (Medtronic, Ireland). Analysis control points were: initial values, the 3rd, 5th and 7th days of treatment. Statistical analysis was performed using the licensed program STATISTICA 12 (StatSoft Inc., USA). The significance level of differences wass p<0.05. Results. The initial values of the median average daily glucose level in patients of the groups I and II were slightly elevated relative to normal values and were 8.25 [5.2–10.6] mmol/l and 7.60 [5.2-9.2] mmol/l, respectively, while the TIR% index was 64.5±8.81% in patients of group I and 66.3±8.28% in patients of group II, which indicated the negative impact of stroke and OSAS on the blood glucose regulation. In confirmation of this, the coefficient of glucose variations was pathologically elevated and amounted up to 17.1% [15.4–18.9] in patients of the group I, and 16.2% [14.6–18.1] in the patients of the group II. After 7 days of continuous monitoring of glycemic status, we’ve determined a statistically significant decrease in the average daily glucose level in patients of the group I at 24.8% (p<0.05) relative to the initial values up to the level of 6.20 [4.8-7.7] mmol/ l, and in patients of the group II at 21.7% (p<0.004) up to the level of 5.95 [4.8–6.7] mmol/l. The coefficient of variations of glucose was equal to 15.3% [13.5–17.2] in patients of the group I and 8.5% [7.5–8.9] in patients of the group II. Glucose variability in patients of the group I did not statistically significantly change (p<0.18) compared to the initial data, instead, in the patients of the group II, the controlled index decreased at 47.5% (p<0.001). The TIR% index was within the desired limits in patients of the group I and was 70.2±6.11%, but compared to the initial values, it did not change statistically. At the same time, in the patients of group II, the TIR% index increased statistically significantly (p<0.001) at 20.9% compared to the initial data and reached the level of 83.9±6.28%. Conclusions. The use of non-invasive respiratory support (CPAP-therapy) in order to correct the negative effects of concomitant OSAS in patients in the acute period of ischemic stroke, contributes to the stable maintenance of the average daily glucose indices and the normalization of the TIR% index up to the level of normal values beginning from the 3rd day of observation. The coefficient of glucose variations against the background of the use of non-invasive respiratory support is statistically likely to decrease to the physiological fluctuations limit.