Anne-Kathrin Brill

BACKGROUND: Sleep-disordered breathing (SDB) is common after ischemic stroke and has been associated with adverse outcomes, yet evidence from large stroke cohorts remains limited. We evaluated the association of SDB severity with all-cause mortality, major adverse cardio- and cerebrovascular events (MACCE), and 3-month functional outcome. METHODS: This retrospective cohort study included consecutive patients with ischemic stroke or transient ischemic attack admitted to Inselspital Bern between 2017 and 2021 who underwent in-hospital respiratory polygraphy. SDB severity was classified according to the apnea-hypopnea index as mild (5–P for trend=0.009). Moderate and severe SDB were associated with unfavorable 3-month functional outcome (adjusted odds ratio, 1.74 [95% CI, 1.01–3.04] and 2.48 [95% CI, 1.45–4.31], respectively; P for trend <0.001). CONCLUSIONS: Severe SDB was independently associated with all-cause mortality, whereas SDB severity was associated with first postindex MACCE and unfavorable 3-month functional outcome. Acute-phase SDB assessment may improve prognostic risk stratification.

Background: Sleep–wake-circadian disorders are prevalent and contribute substantially to morbidity, mortality and reduced quality of life. Evaluation in real-world settings is essential to capture their complexity and association with long-term outcomes. Most sleep-wake registries are restricted to selected populations, lack systematic integration of objective sleep-wake-circadian assessments with the clinical data and provide limited follow-up. To address these limitations, we established the Bern Sleep-Wake Registry based on real-world data from a tertiary University Hospital sleep center. Methods: The registry includes data from patients referred to the multidisciplinary Sleep-Center at Inselspital, University Hospital Bern (founded in 1990), from the year 2000 onwards who underwent at least one objective assessment such as polysomnography, daytime sleep-wake recordings, vigilance tests, and actigraphy. The registry integrates clinical information, questionnaire scores, outputs of objective assessments and raw signal data, and is regularly updated to incorporate new patients and longitudinal follow-up information. Results: As of September 2025, records from over 11’000 patients were evaluated (median age: 50 years (interquartile range 36, 61); 65% male). The most common sleep-wake-circadian disorders were “sleep-related breathing disorders” (67%), “insomnia disorders” (15%) and “central disorders of hypersomnolence” (9%). Available assessments included more than 12’000 polysomnographies, 2’400 multiple sleep latency tests, 2’100 maintenance of wakefulness tests, 1’800 vigilance tests and 4’500 actigraphies. Conclusions: By longitudinally integrating multimodal deep clinical phenotyping with objective assessments and raw physiological signals, the Bern Sleep-Wake Registry provides a foundation for investigating disease trajectories, identifying novel biomarkers and developing data-driven approaches to precise diagnosis, prognosis and individualized treatment.

Introduction: High-flow nasal oxygen therapy (HFNO) for acute respiratory failure (ARF) has been used in the intensive care units (ICUs), but more recently also on respiratory wards (RWs). Little data are available regarding in-hospital, short-term and long-term mortality in the latter setting. Methods: We performed a retrospective analysis of patients ≥ 16 years old treated with HFNO on the RW between 01/2020 and 09/2022 with a follow-up until 09/2023. We grouped patients by main diagnosis and do-not-intubate (DNI) order. Cox proportional hazard models were used. Results: We analyzed 145 HFNO patients (36% women, median age 70 years [quartile range {Q1–Q3} 62–79], BMI 25.8 [Q1-Q3: 22.6–28.5] kg/m2) with ARF mostly due to COVID-19 (n = 84, 57.9%), other pneumonia (n = 25, 17.2%), and mixed other diagnoses (n = 36, 25%). A total of 71 (48.9%) patients started HFNO on ICU and continued on the RW, treatment was tolerated in 94% of patients. In-hospital mortality was 24.8% (n = 35), of whom 33 patients had a DNI-order. The mortality rates after 30 days, 90 days, and 1 year were 30% (n = 44), 38% (n = 54), and 43% (n = 62). Long-term mortality did not differ between diagnostic groups (p > 0.05), a higher BMI was associated with lower mortality (hazard ratio [HR] 0.95 [95% CI 0.91–0.99]). A DNI-order and a palliative setting were associated with higher mortality (1 year: HR 3.03 [95% CI 1.15–7.69], p = 0.024 and HR 4.01 [2.21–7.26], p < 0.001). Conclusion: In our cohort of patients with ARF treated with HFNO, the underlying diagnosis of ARF was not associated with an increased mortality risk. In DNI patients, RW HFNO allows for advanced care without burdening ICU resources.

Summary: Sleep‐disordered breathing (SDB) is linked to cognitive dysfunction. Although SDB is common in stroke patients, the impact of SDB and its early treatment on cognitive functioning after stroke remains poorly investigated. Therefore, we explored the association between SDB and post‐stroke cognitive functioning, including the impact of early SDB treatment with adaptive servo‐ventilation (ASV) on cognitive recovery from acute event to 3 months post‐stroke. We used data from two studies, which included ischaemic stroke patients (n = 131) and no‐stroke controls (n = 37) without SDB (apnea–hypopnea index, AHI n = 30) versus SDB ASV‐ (n = 29) with cognitive recovery. In an exploratory subanalysis, compliant SDB ASV+ (n = 14) versus SDB ASV‐ showed improvements with ASV in visual memory and cognitive flexibility. Combining the stroke and non‐stroke datasets, SDB (n = 85) versus no‐SDB (n = 83) was associated with deficits in visual memory and response inhibition independently of stroke. SDB ASV‐ versus no‐SDB (n = 51) was associated with less improvement in visual memory. There was no substantial evidence for benefits of intention‐to‐treat ASV on cognitive recovery. Exploratory analysis indicated that compliant ASV treatment could benefit visual memory and cognitive flexibility, whereas untreated SDB could contribute to a poor recovery of visual memory.

Sleep is essential for health, well-being, creativity, and productivity. Sleep loss and sleep–wake circadian disorders (SWCDs) affect at least one in three individuals but are underdiagnosed and undertreated for different reasons: First, the importance of sleep health and, second, the burden of sleep loss and SWCDs are underestimated. Third, education in sleep medicine is insufficient and health care-related sleep research is underdeveloped. Fourth, the validation and implementation of tele-sleep medicine approaches and novel devices to monitor SWCDs are still insufficient. Fifth, the reimbursement of sleep medicine in most countries is inadequate and the availability of specialized care is limited to a few centers. The Swiss Sleep House Bern (SSHB) was founded in 2022 to address these challenges and eventually promote better care for patients with SWCDs and improve sleep health for the broader population. The interdisciplinary and interprofessional team of the SSHB, which is integrated in the Bernese Interdisciplinary Sleep-Wake-Epilepsy Center, links sleep specialists with primary care providers to offer a rapid and accessible triage and first-level management of sleep complaints and SWCDs. The SSHB also promotes awareness and offers educational programs on sleep health and SWCDs, performs health care research, and fosters the implementation of new technologies, data science, and telemedicine into clinical routine.

BACKGROUND: Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke. Little is known about the impact of comorbid SDB and AF on long-term outcomes after stroke. METHODS: In this prospective cohort study, 353 patients with acute ischemic stroke or transient ischemic attacks were analyzed. Patients were screened for SDB by respiratory polygraphy during acute hospitalization. Screening for AF was performed using a 7-day ECG up to 3× in the first 6 months. Follow-up visits were scheduled at 1, 3, 12, 24, and 36 months poststroke. Cox regression models adjusted for various factors (age, sex, body mass index, hypertension, diabetes, dyslipidemia, and heart failure) were used to assess the impact of comorbid SDB and AF on subsequent death or cerebro-cardiovascular events. RESULTS: Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67 (interquartile range, 57–74) years with 63% males. Moderate-to-severe SDB (apnea-hypopnea index score, ≥15/h) was present in 118 (33.4%) patients. Among the 56 (15.9%) patients with AF, 28 had comorbid moderate-to-severe SDB and AF. Over 36 months, there were 12 deaths and 67 recurrent cerebro-cardiovascular events. Patients with comorbid moderate-to-severe SDB and AF had a higher risk of subsequent death or cerebro-cardiovascular events compared with those with only moderate-to-severe SDB without AF (hazard ratio, 2.49 [95% CI, 1.18–5.24]) and to those without moderate-to-severe SDB or AF (hazard ratio, 2.25 [95% CI, 1.12–4.50]). However, no significant difference was found between the comorbid moderate-to-severe SDB and AF group and the group with only AF without moderate-to-severe SDB (hazard ratio, 1.64 [95% CI, 0.62–4.36]). CONCLUSIONS: Comorbid moderate-to-severe SDB and AF significantly increase the risk of long-term mortality or recurrent cerebro-cardiovascular events after acute ischemic stroke. Considering both conditions as cumulative and modifiable cerebro-cardiovascular risk factors is of interest for the management of acute stroke. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02559739.

Zusammenfassung. Bei der Treatment-Emergent Central Sleep Apnea (TECSA) entwickeln betroffene Personen mit obstruktiver Schlafapnoe unter Therapie mit einer Überdruckventilation neu eine zentrale Schlafapnoe (AHI zentral ≥5/h), die nicht durch andere Ursachen erklärt werden kann. Die Pathophysiologie der TECSA ist unvollständig geklärt. Eine zentrale Rolle scheint das PaCO2 und die damit verbundene Apnoeschwelle einzunehmen. Die Häufigkeit der TECSA variiert (1,8–20%), in etwa 2/3 der Fälle ist es unter Fortführung der Therapie selbstlimitierend. Bei Persistenz oder neuem Auftreten im späteren Verlauf der Überdrucktherapie sind weitere Abklärungen (z.B. Echokardiografie, neurologische Untersuchung, Medikamentenanamnese) angezeigt. Effektive Therapiemöglichkeiten beinhalten unter anderem eine Umstellung der Beatmungstherapie (adaptive Servoventilation oder Bilevel-Ventilation mit Back-up-Frequenz) oder eine zusätzliche nächtliche Sauerstoffsupplementation; dies sind meist Einzelfallentscheidungen.