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: 17.33). 03/2008; 168(3):297-301. DOI: 10.1001/archinternmed.2007.70
Source: PubMed


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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Available from: Carin Sahlin
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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.
    Full-text · Article · Jul 2014 · Journal of Sleep Research
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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.
    Full-text · Article · May 2014
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    • "OSA is highly prevalent in patients with hypertension, coronary artery disease, stroke, and atrial fibrillation [3], [4]. OSA has been reported to be associated with increased cardiovascular mortality [5], [6], [7], [8], [9] and all-cause mortality [6], [9], [10], [11], [12], [13], [14], and in particular with coexistence of OSA and cardiovascular disease [15], [16], [17], [18], [19]. However, many of these reports did not examine the contributing role of confounding factors [14], nor the relationship with the severity of OSA [7], [13]; conflicting results whether this association is independent of obesity and co-morbidities remain [6], [9], [12], [14]. "
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    ABSTRACT: Studies have reported inconsistent findings regarding the association between obstructive sleep apnea (OSA) and future risks of cardiovascular and all-cause mortality. We conducted a meta-analysis to investigate whether OSA is an independent predictor for future cardiovascular and all-cause mortality using prospective observational studies. Electronic literature databases (Medline and Embase) were searched for prospective observational studies published prior to December 2012. Only observational studies that assessed baseline OSA and future risk of cardiovascular and all-cause mortality were selected. Pooled hazard risk (HR) and corresponding 95% confidence intervals (CI) were calculated for categorical risk estimates. Subgroup analyses were based on the severity of OSA. Six studies with 11932 patients were identified and analyzed, with 239 reporting cardiovascular mortality, and 1397 all-cause mortality. Pooled HR of all-cause mortality was 1.19 (95% CI, 1.00 to 1.41) for moderate OSA and 1.90 (95% CI, 1.29 to 2.81) for severe OSA. Pooled HR of cardiovascular mortality was 1.40 (95% CI, 0.77 to 2.53) for moderate OSA and 2.65 (95% CI, 1.82 to 3.85) for severe OSA. There were no differences in cardiovascular mortality in continuous positive airway pressure (CPAP) treatment compared with healthy subjects (HR 0.82; 95% CI, 0.50 to 1.33). Severe OSA is a strong independent predictor for future cardiovascular and all-cause mortality. CPAP treatment was associated with decrease cardiovascular mortality.
    Full-text · Article · Jul 2013 · PLoS ONE
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