Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

Abstract

BACKGROUND: Specific clinical and demographic risk factors may be associated with improving or worsening neurologic outcomes within a population of acute ischemic stroke (AIS) patients with a history of obstructive sleep apnea (OSA). The objective of this study was to determine the changes in neurologic outcome during a 14-day recovery as it relates to initial stroke severity in AIS patients with OSA. METHODS: This retrospective study analyzed baseline clinical risk factors and demographic data collected in a regional stroke center from January 2010 to June 2016. Our primary endpoint measure was the National Institutes of Health Stroke Scale (NIHSS) score and our secondary endpoint measures included the clinical factors associated with improving (NIHSS score ≤7) or worsening (NIHSS score >7) neurological outcome. The relative contribution of each variable to stroke severity and related outcome was determined using a logistic regression. The regression models were checked for the overall correct classification percentage using a Hosmer–Lemeshow test, and the sensitivity of our models was determined by the area under the receiver operating characteristic curve. RESULTS: A total of 5469 AIS patients were identified. Of this, 96.89% did not present with OSA while 3.11% of AIS patients presented with OSA. Adjusted multivariate analysis demonstrated that in the AIS population with OSA, atrial fibrillation (AF) (odds ratio [OR] = 3.36, 95% confidence interval [CI], 1.289–8.762, P = 0.013) and changes in ambulatory status (OR = 2.813, 95% CI, 1.123–7.041, P = 0.027) showed an association with NIHSS score >7 while being Caucasian (OR = 0.214, 95% CI, 0.06–0.767, P = 0.018) was associated with NIHSS score ≤7. CONCLUSION: In AIS patients with OSA, AF and changes in ambulatory status were associated with worsening neurological outcome while Caucasian patients were associated with improving neurological outcome. Our findings may have significant implications for patient stratification when determining treatment protocols with respect to neurologic outcomes in AIS patients with OSA.

Breathing Exercises for Improving Cognitive Function in Patients with Stroke

“…In a study by Yaggi et al conducted on 1022 adults with no history of stroke or myocardial infarction, the risk of stroke was shown to increase as the severity of OSA increased [ 134 ]. This result was verified in further follow-up studies and meta-analyses, where adults with OSA showed approximately a two-fold higher risk of stroke [ 135 , 136 , 137 , 138 , 139 ]. Additionally, untreated OSA after acute stroke increases long-term mortality and neurological outcomes [ 125 , 126 ], which highlights the importance of rapid treatment of post-stroke OSA.…”

Stroke Severity in Ischemic Stroke Patients with a History of Diastolic Blood Pressure Treated in a Telestroke Network

“…We observed that AIS patients with a history of hypertension and elevated measured diastolic pressure after initial stroke were associated with increased stroke severity. Hypertension is associated with an increased risk of initial stroke and the control of hypertension reduces this risk [ 21 , 58 , 59 ]. Randomized control trials have continuously challenged the “lower, the better” hypothesis for hypertension [ 6 ].…”

Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network

“…Generally, women are more likely to present with comorbidities of atrial fibrillation [25] and hypertension [26], whereas men are more likely to present with congestive heart disease and diabetes [27]. While existing studies [25][26][27] reveal evidence of a gender difference in stroke symptoms, past clinical history and comorbidities in the non-telestroke setting, how these may contribute to stroke severity and possible gender difference in the telestroke setting is not fully understood.…”

“…Generally, women are more likely to present with comorbidities of atrial fibrillation [25] and hypertension [26], whereas men are more likely to present with congestive heart disease and diabetes [27]. While existing studies [25][26][27] reveal evidence of a gender difference in stroke symptoms, past clinical history and comorbidities in the non-telestroke setting, how these may contribute to stroke severity and possible gender difference in the telestroke setting is not fully understood. A significant benefit of the telestroke network is that it provides a high quality of acute stroke care, including diagnostic procedures, management of stroke comorbidities, and access to allied health assessments than in control hospitals.…”

“…Patients with an NIHSS score ≤7 at the time of admission are reported to be more likely to make positive neurologic progress, whereas AIS patients presenting with an NIHSS score >7 are more likely to experience worsening neurologic outcomes after a hemispheric stroke [8]. Moreover, findings from existing studies [10, 24, 25] reveal that there is a strong predictive value of early NIHSS scores, which will improve early identification of neurologic functional deficits in hemispheric stroke patients, both in non-telestroke and telestroke settings.…”