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

Abstract

BackgroundObstructive sleep apnea (OSA) is associated with cerebral small vessel disease (CSVD). Nonetheless, whether OSA-risk determined by a simple screening questionnaire or indices quantifying nocturnal hypoxemia other than the conventional apnea–hypopnea index (AHI) by the home sleep apnea test (HSAT) associated with CSVD burden remains uncertain.MethodsFrom 2018 to 2021, we recruited patients with transient ischemic attack (TIA)/minor stroke from the Queen Mary Hospital Acute Stroke Unit and TIA/Stroke Outpatient Clinics. Logistic regression models were applied to determine the association of baseline OSA-risk (on STOP-BANG questionnaire) or HSAT-derived indices quantifying nocturnal hypoxemia with global burden/individual markers of CSVD on MRI. Indices included oxygen desaturation (≥3%) index (ODI), minimum oxygen saturation (SpO2), percentage of total sleep time with an oxygen saturation <90% (CT90%), and desaturation duration (≥3%, DesDur).ResultsIn 283 patients with TIA/minor stroke (mean age 65 years, 64% men), OSA-risk was significantly associated with total CSVD score (multivariate-adjusted odds ratio: 1.23, 95% confidence interval 1.01–1.51), presence of lacunes [1.39 (1.09–1.79)] and burden of basal ganglia PVSs [1.32 (1.06–1.67)]. In 85/283 patients who completed HSAT, neither AHI, minimum SpO2 nor CT90% was associated with CSVD burden. Nonetheless, ODI and DesDur remained significantly associated with total CSVD score after covariate adjustment: ODI [1.04 (1.01–1.07)] and DesDur [1.04 (1.01–1.08)].ConclusionIn patients with TIA/minor stroke, high OSA-risk was associated with a greater CSVD burden. Oxygen desaturation indices (ODI and DesDur) rather than AHI were independently associated with global CSVD burden, indicating that longer and more severe desaturations may contribute to the pathogenesis of CSVD.

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

“…The relationship between OSA and cerebral infarction remains controversial. Studies have suggested that OSA can lead to an adverse prognosis in cerebral infarction, impair brain function, exacerbate cognitive dysfunction, and increase mortality risk (30)(31)(32)(33). The main mechanisms underlying these adverse outcomes include chronic intermittent hypoxia, sympathetic activation, changes in cerebral blood flow, oxidative stress, systemic inflammation, hypercoagulability, and endothelial dysfunction (34,35).…”

Prediction model of obstructive sleep apnea–related hypertension: Machine learning–based development and interpretation study

“…Interestingly, in addition to identifying several known risk factors, multivariate logistic regression and SHAP analysis also found that CT90/10, a variable that had been overlooked in previous cardiovascular studies, also plays an important role in OSA-related hypertension. Previous studies have shown a significant association between CT90 and Coronary Artery Calcium, cerebral small vessel disease and diabetic nephropathy ( 30 – 32 ), but the relationship between CT90 and hypertension has not been explored. The underlying causes by OSA and hypertension have not been fully elucidated.…”