Nocturnal onset ischemic stroke provoked by sleep-disordered breathing advanced with congestive heart failure.

R ecently, sleep-disordered breathing and nocturnal hypoxia have been recognized to increase the risk of cerebrovascular disease. Kirkham et al reported that nocturnal hypoxemia was a predictor of future cerebrovascular events in sickle-cell disease. However, it remains unclear whether nocturnal hypoxemic episodes directly lead to nocturnal onset stroke, because other predisposing conditions might confound the association between sleep-disordered breathing and the risk of stroke. Congestive heart failure is often accompanied by central sleep–disordered breathing. We report here a case of nocturnal onset ischemic stroke directly provoked by sleep-disordered breathing, newly developed together with congestive heart failure.