Infarct location and sleep apnea

Evaluating the potential association in acute ischemic stroke

Stephanie M. Stahl, H. Klar Yaggi, Stanley Taylor, Li Qin, Cristina Ivan, Charles Austin, Jared Ferguson, Radu Radulescu, Lauren Tobias, Jason Sico, Carlos A. Vaz Fragoso, Linda Williams, Rachel Lampert, Edward Miech, Marianne Matthias, John Kapoor, Dawn Bravata

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Methods: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Results: Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. Conclusions: These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients.

Original languageEnglish
Pages (from-to)1198-1203
Number of pages6
JournalSleep Medicine
Volume16
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Sleep Apnea Syndromes
Obstructive Sleep Apnea
Stroke
Polysomnography
Apnea
Transient Ischemic Attack
Arousal
Neuroimaging
Cerebellum
Brain Stem
Blood Vessels
Randomized Controlled Trials
Logistic Models

Keywords

  • CT
  • Infarct
  • MRI
  • Sleep apnea
  • Stroke

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Infarct location and sleep apnea : Evaluating the potential association in acute ischemic stroke. / Stahl, Stephanie M.; Yaggi, H. Klar; Taylor, Stanley; Qin, Li; Ivan, Cristina; Austin, Charles; Ferguson, Jared; Radulescu, Radu; Tobias, Lauren; Sico, Jason; Vaz Fragoso, Carlos A.; Williams, Linda; Lampert, Rachel; Miech, Edward; Matthias, Marianne; Kapoor, John; Bravata, Dawn.

In: Sleep Medicine, Vol. 16, No. 10, 01.10.2015, p. 1198-1203.

Research output: Contribution to journalArticle

Stahl, SM, Yaggi, HK, Taylor, S, Qin, L, Ivan, C, Austin, C, Ferguson, J, Radulescu, R, Tobias, L, Sico, J, Vaz Fragoso, CA, Williams, L, Lampert, R, Miech, E, Matthias, M, Kapoor, J & Bravata, D 2015, 'Infarct location and sleep apnea: Evaluating the potential association in acute ischemic stroke', Sleep Medicine, vol. 16, no. 10, pp. 1198-1203. https://doi.org/10.1016/j.sleep.2015.07.003
Stahl, Stephanie M. ; Yaggi, H. Klar ; Taylor, Stanley ; Qin, Li ; Ivan, Cristina ; Austin, Charles ; Ferguson, Jared ; Radulescu, Radu ; Tobias, Lauren ; Sico, Jason ; Vaz Fragoso, Carlos A. ; Williams, Linda ; Lampert, Rachel ; Miech, Edward ; Matthias, Marianne ; Kapoor, John ; Bravata, Dawn. / Infarct location and sleep apnea : Evaluating the potential association in acute ischemic stroke. In: Sleep Medicine. 2015 ; Vol. 16, No. 10. pp. 1198-1203.
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abstract = "Background: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Methods: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Results: Among 73 patients with complete polysomnography and stroke location data, 58 (79{\%}) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. Conclusions: These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients.",
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T2 - Evaluating the potential association in acute ischemic stroke

AU - Stahl, Stephanie M.

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AU - Taylor, Stanley

AU - Qin, Li

AU - Ivan, Cristina

AU - Austin, Charles

AU - Ferguson, Jared

AU - Radulescu, Radu

AU - Tobias, Lauren

AU - Sico, Jason

AU - Vaz Fragoso, Carlos A.

AU - Williams, Linda

AU - Lampert, Rachel

AU - Miech, Edward

AU - Matthias, Marianne

AU - Kapoor, John

AU - Bravata, Dawn

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N2 - Background: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Methods: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Results: Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. Conclusions: These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients.

AB - Background: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Methods: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Results: Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. Conclusions: These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients.

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KW - MRI

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