Sleep-Disordered Breathing Is Associated With Recurrent Ischemic Stroke

I had to figure out on my own that I needed a sleep study which proved I had light sleep apnea. I don't have it treated with a CPAP because I can't fall asleep with it on.  In the hospital I got the finger pulse oximetry test which showed no oxygenation problems but an official night sleep study showed sleep apnea of 6.5 times an hour.  13 years and no stroke so far.

Sleep-Disordered Breathing Is Associated With Recurrent Ischemic Stroke

Devin L. Brown

,

Fatema Shafie-Khorassani

,

Sehee Kim

,

Ronald D. Chervin

,

Erin Case

,

Lewis B. Morgenstern

,

Azadeh Yadollahi

,

Susan Tower

,

Lynda D. Lisabeth

Originally published12 Feb 2019https://doi.org/10.1161/STROKEAHA.118.023807Stroke. 2019;0

Abstract

Background and Purpose—

Limited data are available about the relationship between sleep-disordered breathing (SDB) and recurrent stroke and mortality, especially from population-based studies, large samples, or ethnically diverse populations.

Methods—

In the BASIC project (Brain Attack Surveillance in Corpus Christ), we identified patients with ischemic stroke (2010–2015). Subjects were offered screening for SDB with the ApneaLink Plus device, from which a respiratory event index (REI) ≥10 defined SDB. Demographics and baseline characteristics were determined from chart review and interview. Recurrent ischemic stroke was identified through active and passive surveillance. Cause-specific proportional hazards models were used to assess the association between REI (modeled linearly) and ischemic stroke recurrence (as the event of interest), and all-cause poststroke mortality, adjusted for multiple potential confounders.

Results—

Among 842 subjects, the median age was 65 (interquartile range, 57–76), 47% were female, and 58% were Mexican American. The median REI was 14 (interquartile range, 6–26); 63% had SDB. SDB was associated with male sex, Mexican American ethnicity, being insured, nonsmoking status, diabetes mellitus, hypertension, lower educational attainment, and higher body mass index. Among Mexican American and non-Hispanic whites, 85 (11%) ischemic recurrent strokes and 104 (13%) deaths occurred, with a median follow-up time of 591 days. In fully adjusted models, REI was associated with recurrent ischemic stroke (hazard ratio, 1.02 [hazard ratio for one-unit higher REI, 95% CI, 1.01–1.03]), but not with mortality alone (hazard ratio, 1.00 [95% CI, 0.99–1.02]).

Conclusions—

Results from this large population-based study show that SDB is associated with recurrent ischemic stroke, but not mortality. SDB may therefore represent an important modifiable risk factor for poor stroke outcomes.

Footnotes

Correspondence to Devin L. Brown, MD, MS, Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Email devinb@umich.edu