Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study

doi:10.1016/j.sleep.2014.04.003

. 2014 Aug;15(8):887-91.

doi: 10.1016/j.sleep.2014.04.003. Epub 2014 May 2.

Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study

Affiliations

¹ Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA. Electronic address: devinb@umich.edu.
² Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
³ Department of Neurology, 100 High Street, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA.
⁴ Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA; Department of Epidemiology, 1014 SPH I, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
⁵ Sleep Disorders Center, University of Michigan, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109-5845, USA.

PMID: 24916097
PMCID: PMC4117733
DOI: 10.1016/j.sleep.2014.04.003

Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study

Devin L Brown et al. Sleep Med. 2014 Aug.

. 2014 Aug;15(8):887-91.

doi: 10.1016/j.sleep.2014.04.003. Epub 2014 May 2.

Affiliations

¹ Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA. Electronic address: devinb@umich.edu.
² Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
³ Department of Neurology, 100 High Street, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA.
⁴ Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA; Department of Epidemiology, 1014 SPH I, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
⁵ Sleep Disorders Center, University of Michigan, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109-5845, USA.

PMID: 24916097
PMCID: PMC4117733
DOI: 10.1016/j.sleep.2014.04.003

Abstract

Background: Association between cerebral infarction site and poststroke sleep-disordered breathing (SDB) has important implications for SDB screening and the pathophysiology of poststroke SDB. Within a large, population-based study, we assessed whether brainstem infarction location is associated with SDB presence and severity.

Methods: Cross-sectional study was conducted on ischemic stroke patients in the Brain Attack Surveillance in Corpus Christi (BASIC) project. Subjects underwent SDB screening (median 13days after stroke) with a well-validated cardiopulmonary sleep apnea-testing device (n=355). Acute infarction location was determined based on review of radiology reports and dichotomized into brainstem involvement or none. Logistic and linear regression models were used to test the associations between brainstem involvement and SDB or apnea/hypopnea index (AHI) in unadjusted and adjusted models.

Results: A total of 38 participants (11%) had acute infarction involving the brainstem. Of those without brainstem infarction, 59% had significant SDB (AHI⩾10); the median AHI was 13 (interquartile range (IQR) 6, 26). Of those with brainstem infarction, 84% had SDB; median AHI was 20 (IQR 11, 38). In unadjusted analysis, brainstem involvement was associated with over three times the odds of SDB (odds ratio (OR) 3.71 (95% confidence interval (CI): 1.52, 9.13)). In a multivariable model, adjusted for demographics, body mass index (BMI), hypertension, diabetes, coronary artery disease, atrial fibrillation, prior stroke/transient ischemic attack (TIA), and stroke severity, results were similar (OR 3.76 (95% CI: 1.44, 9.81)). Brainstem infarction was also associated with AHI (continuous) in unadjusted (p=0.004) and adjusted models (p=0.004).

Conclusions: Data from this population-based stroke study show that acute infarction involving the brainstem is associated with both presence and severity of SDB.

Keywords: Brainstem; Infarction; Portable monitor; Risk factor; Sleep-disordered breathing; Stroke.

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References

1. Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke. 2006;37:2317–2321. - PubMed
1. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE, et al. Obstructive Sleep Apnea Hypopnea and Incident Stroke: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2010;182:269–277. - PMC - PubMed
1. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–2041. - PubMed
1. Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, et al. Obstructive Sleep Apnea Is a Risk Factor for Death in Patients With Stroke: A 10-Year Follow-up. Arch Intern Med. 2008;168:297–301. - PubMed
1. Turkington PM, Allgar V, Bamford J, Wanklyn P, Elliott MW. Effect of upper airway obstruction in acute stroke on functional outcome at 6 months. Thorax. 2004;59:367–371. - PMC - PubMed

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[1] Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke. 2006;37:2317–2321. - PubMed

[2] Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke. 2006;37:2317–2321. - PubMed

[3] Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE, et al. Obstructive Sleep Apnea Hypopnea and Incident Stroke: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2010;182:269–277. - PMC - PubMed

[4] Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE, et al. Obstructive Sleep Apnea Hypopnea and Incident Stroke: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2010;182:269–277. - PMC - PubMed

[5] Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–2041. - PubMed

[6] Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–2041. - PubMed

[7] Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, et al. Obstructive Sleep Apnea Is a Risk Factor for Death in Patients With Stroke: A 10-Year Follow-up. Arch Intern Med. 2008;168:297–301. - PubMed

[8] Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, et al. Obstructive Sleep Apnea Is a Risk Factor for Death in Patients With Stroke: A 10-Year Follow-up. Arch Intern Med. 2008;168:297–301. - PubMed

[9] Turkington PM, Allgar V, Bamford J, Wanklyn P, Elliott MW. Effect of upper airway obstruction in acute stroke on functional outcome at 6 months. Thorax. 2004;59:367–371. - PMC - PubMed

[10] Turkington PM, Allgar V, Bamford J, Wanklyn P, Elliott MW. Effect of upper airway obstruction in acute stroke on functional outcome at 6 months. Thorax. 2004;59:367–371. - PMC - PubMed

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Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study

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Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study

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