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. 2020 Dec;24(4):1495-1505.
doi: 10.1007/s11325-019-02010-2. Epub 2020 Jan 14.

Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

Akseli Leino  1   2 , Susanna Westeren-Punnonen  3 , Juha Töyräs  3   4   5 , Sami Myllymaa  3   4 , Timo Leppänen  3   4 , Salla Ylä-Herttuala  3 , Anu Muraja-Murro  3 , Anne-Mari Kantanen  6 , Jaana Autere  6 , Pekka Jäkälä  6   7 , Esa Mervaala  3   8 , Katja Myllymaa  3
Affiliations

Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

Akseli Leino et al. Sleep Breath. 2020 Dec.

Abstract

Purpose: Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing.

Methods: Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients.

Results: Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients.

Conclusion: Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA.

Keywords: Apnea-hypopnea index; Severity estimation; Sleep apnea; Stroke; Transient ischemic attack.

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Conflict of interest statement

Dr. Kantanen has received a speaker’s honoraria from Orion, Boehringer Ingelheim, MSD, BMS.

Figures

Fig. 1
Fig. 1
The distributions of individual apnea (mixed and central included, a, c), obstructive apnea (a, c) and hypopnea (b, d), durations in stroke (a, b) and TIA (c, d) patients, and their gender, age, and BMI-matched reference patients. The distributions are adjusted for the total analyzed time of the corresponding group
Fig. 2
Fig. 2
The distributions of individual desaturation event durations (a, c) and depths (b, d) in stroke (a, b) and TIA (c, d) patients and their gender, age, and BMI-matched reference patients. The distributions are adjusted for the total analyzed time of the corresponding group
Fig. 3
Fig. 3
The distributions of desaturation area (a, c) and individual event severity (apneas and hypopneas combined, b, d) for individual events in TIA (c, d) and stroke patients (a, b) and their gender, age, and BMI-matched reference patients. The distributions are adjusted for total analyzed time of the corresponding group
Fig. 4
Fig. 4
The proportion (%) of undiagnosed OSA in stroke (a) and TIA (b) patients, and diagnosed OSA in gender, age, and BMI-matched reference patients within different OSA severity categories
See this image and copyright information in PMC

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