**2.3 Treatment of sleep-disordered breathing in patients with ischemic stroke**

Treatment of sleep-disordered breathing in patients with ischemic stroke is strongly dependent on the patient's clinical condition (Hui, 2002). It was shown that among patients with profound neurological deficit CPAP treatment results are unsatisfactory and do not bring the improvement of respiratory parameters (Sandberg, 2001; Wessendorf, 2001). These failures are mainly due to poor tolerance of CPAP and poor compliance among patients with stroke (Sandberg, 2001; Wessendorf, 2001; Hui, 2002). Results published in 2005 regarding the introduction of CPAP treatment in patients with first episode of ischemic stroke and severe obstructive sleep apneas (AHI> 20) showed a significantly lower occurrence of subsequent vascular events (cerebral and cardiac) in patients treated with CPAP - 6 , 7% compared with 36% in patients not treated within two months of follow-up (Martinez-Garcia, 2005). Other authors did not observe statistically significant benefit from the introduction of CPAP treatment in stroke patients with severe obstructive sleep apneas (AHI> 30) (Hsu, 2006). Further prospective study on 449 patients with mild and severe OSAS and CPAP treatment, showed significantly lower risk of cardiovascular event, including stroke (Buchner, 2007). Therapy of patients with severe obstructive sleep apneas and arterial hypertension is postulated as a primary prophylaxis of ischemic stroke (Goldstein, 2006). Recent prospective study in 223 in stroke patients with concomitant obstructive sleep apneas treated with CPAP have reported that treated patients have reduced risk of death compared with not treated in 5-years follow-up (Martinez-Garcia, 2009). It should be noted that the failure of CPAP treatment is usually the result of a difficult cooperation and intolerance of treatment in patients after ischemic stroke. Although there are discrepant reports in the literature, the method of CPAP treatment appears to be effective in preventing further stroke incidents and reduces the risk of death if there is good tolerance of this type of treatment. These results should not limit the interest of researchers in the problem of obstructive sleep apnea in stroke patients. There are several recognized methods of prevention and treatment of sleep-disordered breathing, which can be used successfully in patients with a history of ischemic stroke. These methods include weight reduction, improving sleep hygiene - proper sleep position, avoiding the supine position, avoiding use of alcohol before bedtime, and very important issue - limitation of the use of sleeping pills, particularly the group of benzodiazepines, which may lead to depression of central respiratory center and worsen SDB. Surgical treatment has a prominent place in the treatment of SDB. Correction of the anatomical defects of nasopharynx results in many patients in reduction of the number and severity of obstructive sleep apneas. It is important among stroke patients to select a group with sleep-disordered breathing because of a double benefit - diagnostic and therapeutic, as it allows to modify on of the risk factor-SDB in these patients.
