Increased Risk of Ischemic Stroke during Sleep in Apneic Patients

Abstract

Background and PurposeThe literature indicates that obstructive sleep apnea (OSA) increases the risk of ischemic stroke. However, the causal relationship between OSA and ischemic stroke is not well established. This study examined whether preexisting OSA symptoms affect the onset of acute ischemic stroke.MethodsWe investigated consecutive patients who were admitted with acute ischemic stroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSA prior to stroke. The collected stroke data included the time of the stroke onset, risk factors, and etiologic subtypes. The association between preceding OSA symptoms and wake-up stroke (WUS) was assessed using multivariate logistic regression analysis.ResultsWe identified 260 subjects with acute ischemic strokes with a definite onset time, of which 25.8% were WUS. The presence of preexisting witnessed or self-recognized sleep apnea was the only risk factor for WUS (adjusted odds ratio=2.055, 95% confidence interval=1.035–4.083, p=0.040).ConclusionsPreexisting symptoms suggestive of OSA were associated with the occurrence of WUS. This suggests that OSA contributes to ischemic stroke not only as a predisposing risk factor but also as a triggering factor. Treating OSA might therefore be beneficial in preventing stroke, particularly that occurring during sleep.

No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results

“…This topic was researched by Barreto et al, Haula et al, and Schütz et al [ 32 , 33 , 34 ] and the results of cited studies suggested that preexisting sleep apnea is associated with the occurrence of WUS or even with worse short-term outcomes measured in mRS [ 33 ]. Kim et al in 2018, using the Berlin Questionnaire [ 10 ], found that preexisting witnessed or self-recognized sleep apnea was significantly more frequent in WUS when compared to the non-WUS population (28.3% vs. 16.6%, p = 0.036). In the same study, the presence of preexisting witnessed or self-recognized sleep apnea was the only risk factor for WUS (adjusted odds ratio = 2.055, 95% confidence interval = 1.035–4.083, p = 0.040) [ 10 ].…”

“…A recent meta-analysis of 13 studies’ results showed that sleep apnea syndrome (SAS) is significantly higher in WUS patients, with significantly higher apnea-hypopnea index (AHI; 95% confidence interval: 1.38–14.11; p = 0.017) and oxygen desaturation index (ODI; 95% confidence interval: 0.261–7.438; p = 0.035) [ 8 ]. Increased risk of stroke in these patients may be mediated by hemodynamic changes due to sleep apnea, oxidative stress, endothelial dysfunction, sympathetic overactivity, metabolic dysregulation, accelerated hypertension, paradoxical embolism, or arrhythmogenesis [ 9 , 10 ]. Polysomnography (PSG) is a gold standard diagnostic tool for the complex estimation of SDB.…”

Naoluo Xintong capsule ameliorates apoptosis induced by endoplasmic reticulum stress in rats with cerebral ischemia/ reperfusion injury

“…Stroke is characterized by high morbidity, mortality and disability rates, with World Health Organization (WHO) surveys showing that 15 million new stroke cases occur per year worldwide (1)(2)(3). Effective protection against ischemic brain damage is a worldwide conundrum, necessitating research into novel approaches for control of ischemiareperfusion (I/R) injury.…”

Fatores de risco à síndrome da apneia obstrutiva do sono no adulto

“…Além disso, a SAOS pode contribuir para o acidente vascular cerebral (AVC) isquêmico, não apenas como um fator predisponente, mas também como um fator desencadeante. O tratamento da SAOS pode, portanto, ser benéfico na prevenção do AVC, particularmente no que ocorre durante o sono 10 .…”