Obstructive Sleep Apnea as a Risk Factor for Intracerebral Hemorrhage

Abstract

Background and Purpose: To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls. Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid OSA. We performed logistic regression analyses to evaluate the association between OSA and ICH. Results: Two thousand and sixty-four (71%) cases and 1516 (52%) controls were classified as having OSA by the Berlin Questionnaire. Cases with OSA were significantly more likely to be male and have hypertension, heart disease, hyperlipidemia, and higher body mass index compared with those without OSA. OSA was more common among cases compared with controls (71% versus 52%, odds ratio, 2.28 [95% CI, 2.05–2.55]). In a multivariable logistic regression model, OSA was associated with increased risk for ICH (odds ratio, 1.47 [95% CI, 1.29–1.67]). Conclusions: OSA is a risk factor for ICH.

Prevalence and Determinants of Sleep Apnea in Patients with Stroke: A Meta-Analysis

“…31,32 Consistent with findings from our meta-analysis, a recent large cohort study has shown that OSA, as indicated by the Berlin questionnaire, was a significant risk factor for intracerebral hemorrhage. 33 Future studies on early OSA screening in patients with hemorrhagic stroke would be helpful to understand the mechanisms between OSA and stroke subtypes.…”

Intermittent hypoxia mimicking obstructive sleep apnea aggravates early brain injury following ICH via neuroinflammation and apoptosis

“…oSa induces oxidative stress and activation of the inflammatory system, resulting in the production of reactive oxygen species (roS); roS may be a potential therapeutic target for ameliorating hypoxia-induced cell death and tissue injury (44). Furthermore, an increasing number of studies have demonstrated an association between oSa and cognitive impairment and cnS disease (19)(20)(21)(22)(24)(25)(26).…”

“…Previous clinical studies reported that oSa aggravates eBi, increases mortality rate and worsens overall outcomes of patients with icH (22,37). Thus, an icH model was constructed and chronic (c)iH was used to construct the oSa model (Fig.…”

“…numerous factors, including hypertension, obstructive sleep apnea (oSa), smoking, obesity and hyperlipidemia, can induce intracranial aneurysms, promote aneurysm rupture, aggravate early brain injury (eBi) and worsen the overall outcome of patients with vascular aneurysm following hemorrhagic stroke (19)(20)(21). Geer et al (22) also reported that the incidence rate of hypertension, heart disease and hyperlipidemia, as well as body mass index, were higher in patients with oSa than in those without. a multivariable logistic regression model showed that oSa is associated with an increased risk of icH in a recent study (23).…”

Associations of sleep apnea risk and oxygen desaturation indices with cerebral small vessel disease burden in patients with stroke

“…Several studies have shown that a high OSA-risk is associated with an increased risk of intracerebral hemorrhage ( 12 ), impaired cerebrovascular reactivity ( 13 ), and presence of intracranial carotid artery calcification ( 14 ) after stroke. OSA and CSVD may share similar pathophysiological mechanisms via common vascular risk factors, such as hypertension.…”