Obstructive Sleep Apnea Is a Risk Factor for Death in Patients With Stroke

Department of Respiratory Medicine, Umeå University Hospital, SE-901 85 Umeå, Sweden.
Archives of Internal Medicine (Impact Factor: 13.25). 03/2008; 168(3):297-301. DOI: 10.1001/archinternmed.2007.70
Source: PubMed

ABSTRACT Sleep apnea occurs frequently among patients with stroke, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality. We aimed to investigate whether obstructive or central sleep apnea was related to reduced long-term survival among patients with stroke.
Of 151 patients admitted for in-hospital stroke rehabilitation in the catchment area of Umeå from April 1, 1995, to May 1, 1997, 132 underwent overnight sleep apnea recordings at a mean (SD) of 23 (8) days after the onset of stroke. All patients were followed up prospectively for a mean (SD) of 10.0 (0.6) years, with death as the primary outcome; no one was lost to follow-up. Obstructive sleep apnea was defined when the obstructive apnea-hypopnea index was 15 or greater, and central sleep apnea was defined when the central apnea-hypopnea index was 15 or greater. Patients with obstructive and central apnea-hypopnea indexes of less than 15 served as control subjects.
Of 132 enrolled patients, 116 had died at follow-up. The risk of death was higher among the 23 patients with obstructive sleep apnea than controls (adjusted hazard ratio, 1.76; 95% confidence interval, 1.05-2.95; P = .03), independent of age, sex, body mass index, smoking, hypertension, diabetes mellitus, atrial fibrillation, Mini-Mental State Examination score, and Barthel index of activities of daily living. There was no difference in mortality between the 28 patients with central sleep apnea and controls (adjusted hazard ratio, 1.07; 95% confidence interval, 0.65-1.76; P = .80).
Patients with stroke and obstructive sleep apnea have an increased risk of early death. Central sleep apnea was not related to early death among the present patients.

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    • " related breathing disorders ( SBD ) , and specifically obstructive sleep apnea ( OSA ) , have been suggested to be a risk factor for stroke ( Shahar et al . , 2001 ; Yaggi et al . , 2005 ) and an independent predictor of outcome in the affected patients in terms of functional recovery ( Good et al . , 1996 ) and mortality ( Parra et al . , 2004 ; Sahlin et al . , 2008 ) . Furthermore , in a recent randomized controlled study we have shown that early use of nasal continuous positive airway pressure ( nCPAP ) in patients with a first - ever ischaemic stroke with moderate – severe OSA [ apnea – hypopnea index ( AHI ) ≥20 events h À1 ] is associated with a significant improvement in neurological scales c"
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    ABSTRACT: The main purpose of the present analysis is to assess the influence of introducing early nasal continuous positive airway pressure (nCPAP) treatment on cardiovascular recurrences and mortality in patients with a first-ever ischaemic stroke and moderate-severe obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) ≥20 events h(-1) during a 5-year follow-up. Patients received conventional treatment for stroke and were assigned randomly to the nCPAP group (n = 71) or the control group (n = 69). Cardiovascular events and mortality were registered for all patients. Survival and cardiovascular event-free survival analysis were performed after 5-year follow-up using the Kaplan-Meier test. Patients in the nCPAP group had significantly higher cardiovascular survival than the control group (100 versus 89.9%, log-rank test 5.887; P = 0.015) However, and also despite a positive tendency, there were no significant differences in the cardiovascular event-free survival at 68 months between the nCPAP and control groups (89.5 versus 75.4%, log-rank test 3.565; P = 0.059). Early nCPAP therapy has a positive effect on long-term survival in ischaemic stroke patients and moderate-severe OSA.
    Journal of Sleep Research 07/2014; 24(1). DOI:10.1111/jsr.12181 · 2.95 Impact Factor
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    • "Continuous positive airway pressure (CPAP) treatment for OSA in stroke patients has been found to decrease mortality, improve functional recovery, increase subjective well-being and mood, and inhibit recurrent strokes [6] [7] [8] [9] [10]. The effect of central apneas on mortality and functional recovery in stroke patients is less studied, but in one study central apnea did not increase mortality after stroke as OSA did [11]. "
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    ABSTRACT: In acute stroke, OSA has been found to impair rehabilitation and increase mortality but the effect of central apnea is more unclear. The aim of the present study was to evaluate the feasibility of using limited ambulatory recording system (sleep mattress to evaluate nocturnal breathing and EOG-electrodes for sleep staging) in sleep disordered breathing (SDB) diagnostics in mild acute cerebral ischemia patients and to discover the prevalence of various SDB-patterns among these patients. 42 patients with mild ischemic stroke or transient ischemic attack were studied. OSA was found in 22 patients (52.4%). Central apnea was found in two patients (4.8%) and sustained partial obstruction in only one patient (2.4%). Sleep staging with EOG-electrodes only yielded a similar outcome as scoring with standard rules. OSA was found to be common even after mild stroke. Its early diagnosis and treatment would be favourable in order to improve recovery and reduce mortality. Our results suggest that OSA can be assessed by a limited recording setting with EOG-electrodes, sleep mattress, and pulse oximetry.
    05/2014; 2014:317615. DOI:10.1155/2014/317615
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    • "Obstructive sleep apnoea (OSA) is a chronic medical disorder during which patients experience intermittent hypoxia (IH), often for many years prior to diagnosis and treatment (Somers et al. 2008). The exposure to chronic IH is thought to be responsible for many of the long-term cardiovascular consequences associated with OSA (Somers et al. 2008), including systemic hypertension (Morrell et al. 2000; Nieto et al. 2000; Peppard et al. 2000), myocardial infarction (Hung et al. 1990; Shahar et al. 2001), and stroke (Arzt et al. 2005; Yaggi et al. 2005; Sahlin et al. 2008). Although epidemiological studies have highlighted these associations, our understanding of the underlying mechanisms is incomplete. "
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    ABSTRACT: Intermittent hypoxia (IH) is thought to be responsible for many of the long-term cardiovascular consequences associated with obstructive sleep apnoea (OSA). Experimental human models of IH can aid in investigating the pathophysiology of these cardiovascular complications. The purpose of this study was to determine the effects of IH on the cardiovascular and cerebrovascular response to acute hypoxia and hypercapnia in an experimental human model that simulates the hypoxaemia experienced by OSA patients. We exposed 10 healthy, male subjects to IH for 4 consecutive days. The IH profile involved 2 min of hypoxia (nadir = 45.0 mmHg) alternating with 2 min of normoxia (peak = 88.0 mmHg) for 6 h. The cerebral blood flow response and the pressor responses to hypoxia and hypercapnia were assessed after 2 days of sham exposure, after each day of IH, and 4 days following the discontinuation of IH. Nitric oxide derivatives were measured at baseline and following the last exposure to IH. After 4 days of IH, mean arterial pressure increased by 4 mmHg (P < 0.01), nitric oxide derivatives were reduced by 55% (P < 0.05), the pressor response to acute hypoxia increased (P < 0.01), and the cerebral vascular resistance response to hypoxia increased (P < 0.01). IH alters blood pressure and cerebrovascular regulation, which is likely to contribute to the pathogenesis of cardiovascular and cerebrovascular disease in patients with OSA.
    The Journal of Physiology 05/2009; 587(Pt 13):3287-99. DOI:10.1113/jphysiol.2009.171553 · 4.54 Impact Factor
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