Obstructive sleep apnea and stroke: links to health disparities

Ramos, Alberto R.; Seixas, Azizi; Dib, Salim

doi:10.1016/j.sleh.2015.09.005

Cited by 17 publications

(12 citation statements)

References 66 publications

(66 reference statements)

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“…Our findings support prior conclusions that SDB and stroke are highly comorbid, although under-screening and under-diagnosis are common, especially within nonwhite racial and ethnic populations [16][17][18]. Only one patient out of 68 in our cohort had a previous diagnosis of SDB.…”

Section: Discussionsupporting

confidence: 90%

Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA

Petrie

Sturzoiu

Shulman

et al. 2021

JCM

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Sleep disordered breathing (SDB) is highly prevalent, but frequently unrecognized among stroke patients. Polysomnography (PSG) is difficult to perform soon after a stroke. We evaluated the use of screening questionnaires and portable sleep testing (PST) for patients with acute stroke, subarachnoid hemorrhage, or transient ischemic attack to expedite SDB diagnosis and management. We performed a single-center retrospective analysis of a quality improvement study on SDB screening of consecutive daytime, weekday, adult admissions to a stroke unit. We excluded patients who were unable to communicate and lacked available family members. Patients were screened with the Epworth Sleepiness Scale, Berlin Questionnaire, and STOP-BANG Questionnaire and underwent overnight PST and/or outpatient PSG. The 4-item STOP Questionnaire was derived from STOP-BANG for a secondary analysis. We compared the sensitivity and specificity of the questionnaires for the diagnosis of at least mild SDB (apnea hypopnea index (AHI) ≥5) on PST and correlated AHI measurements between PST and PSG using the Spearman correlation. Out of sixty-eight patients included in the study, 54 (80%) were diagnosed with SDB. Only one (1.5%) had a previous SDB diagnosis. Thirty-three patients completed all questionnaires and a PST. The STOP-BANG questionnaire had the highest sensitivity for at least mild SDB (0.81, 95% CI (confidence interval): 0.65–0.92) but a low specificity (0.33, 95% CI 0.10, 0.65). The discrimination of all questionnaires was overall poor (C statistic range 0.502–0.640). There was a strong correlation (r = 0.71) between the AHI results estimated using PST and outpatient PSG among 28 patients. The 4-item STOP Questionnaire was the easiest to administer and had a comparable or better sensitivity than the other questionnaires. Inpatient PSTs were useful for screening in the acute setting to facilitate an early diagnosis of SDB and to establish further outpatient evaluations with sleep medicine.

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Section: Discussionsupporting

confidence: 90%

Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA

Petrie

Sturzoiu

Shulman

et al. 2021

JCM

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“…OSA may lead to stroke through its associations with potent vascular risk factors, such as hypertension, diabetes mellitus, obesity, and atrial fibrillation. OSA may also increase stroke and CVD risk through reduction in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, increased platelet activation, inflammation, and oxidative stress related to the intermittent hypoxemia–reoxygenation and arousals associated to increased sympathetic tone ( 10 ). The treatment of OSA has been considered an important intervention for reducing the morbidity and mortality associated with stroke and CVD ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Obstructive Sleep Apnea Phenotypes and Markers of Vascular Disease: A Review

et al. 2017

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Obstructive sleep apnea (OSA) is a chronic and heterogeneous disorder that leads to early mortality, stroke, and cardiovascular disease (CVD). OSA is defined by the apnea–hypopnea index, which is an index of OSA severity that combines apneas (pauses in breathing) and hypopneas (partial obstructions in breathing) associated with hypoxemia. Yet, other sleep metrics (i.e., oxygen nadir, arousal frequency), along with clinical symptoms and molecular markers could be better predictors of stroke and CVD outcomes in OSA. The recent focus on personalized medical care introduces the possibility of a unique approach to the treatment of OSA based on its phenotypes, defined by pathophysiological mechanisms and/or clinical presentation. We summarized what is known about OSA and its phenotypes, and review the literature on factors or intermediate markers that could increase stroke risk and CVD in patients with OSA. The OSA phenotypes where divided across three different domains (1) clinical symptoms (i.e., daytime sleepiness), (2) genetic/molecular markers, and (3) experimental data-driven approach (e.g., cluster analysis). Finally, we further highlight gaps in the literature framing a research agenda.

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“…Secondly, studies have shown that acculturation in the host country might have an impact on the physical health status of immigrants [25]. Chronic illnesses such as obesity, diabetes, and hypertension can in return affect sleep quality [26]. Thirdly, psychosocial factors like socioeconomic status (low education and unemployment), low income, and being unmarried are related to sleep disruption [27].…”

Section: Discussionmentioning

confidence: 99%

Differences in Insomnia Symptoms between Immigrants and Non-Immigrants in Switzerland attributed to Emotional Distress: Analysis of the Swiss Health Survey

Schneeberger

Seixas²,

Schweinfurth

et al. 2019

IJERPH

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Migration can be a stressful experience and may lead to poor health and behavioral changes. The immigrant population in Switzerland is disproportionately burdened by several negative health outcomes, chief among these is mental health issues. The aim of the study was to investigate whether sleep disturbances are more prevalent among immigrants compared to non-immigrants and whether emotional distress might explain sleep differences. Based on the Swiss Health Survey 2012 dataset, we analyzed the data of 17,968 people, of which 3406 respondents were immigrants. We examined variables including insomnia symptoms, emotional distress and clinical and socio-demographic data using unadjusted and adjusted generalized linear models. Compared to non-immigrants, immigrants suffer significantly more often from insomnia symptoms. Immigrants also endured higher levels of emotional distress. Higher values of emotional distress are related to other symptoms of sleep disorders. Immigrants with emotional distress were at significant risk of sleep disturbances. Sleep disparities between immigrants and non-immigrants may be influenced by emotional distress. Migration health care should address emotional distress, a more proximal and modifiable factor, as a possible cause of insomnia symptoms in immigrants.

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Obstructive sleep apnea and stroke: links to health disparities

Cited by 17 publications

References 66 publications

Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA

Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA

Obstructive Sleep Apnea Phenotypes and Markers of Vascular Disease: A Review

Differences in Insomnia Symptoms between Immigrants and Non-Immigrants in Switzerland attributed to Emotional Distress: Analysis of the Swiss Health Survey

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