Obstructive Sleep Apnea and Wake-up Stroke – A 12 Months Prospective Longitudinal Study

Barreto, Pedro Rodrigues; Diniz, Deborath Lucia de Oliveira; Lopes, José Evanaldo Lima; Barroso, Maria Clara; Daniele, Thiago Medeiros da Costa; Bruin, Pedro Felipe Carvalhedo de

doi:10.1016/j.jstrokecerebrovasdis.2019.104564

Cited by 11 publications

(6 citation statements)

References 33 publications

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“…In this pooled analysis between WUS and NWUS patients, a statistical difference was observed that the prevalence of male gender takes up 63.7% (308/483) of the WUS patients but 59.2% (817/1,379) in the NWUS patients (OR 1.27, 95% CI: 1.02–1.58; p = 0.03; online suppl. Table 1), which is inconsistent with the former studies where no significant difference was observed between male and female [8, 11, 14, 19]. Furthermore, in the gender-stratified analyses of WUS, consistent results concluded that WUS is associated with SDB in men but not in women [9, 25].…”

Section: Discussioncontrasting

confidence: 62%

“…In this process, studies unrelated to our topic and inappropriate types of studies were excluded. After reviewing the full text and according to the inclusion and exclusion criteria, 13 studies were considered eligible and included in the meta-analysis with 1 study excluded for the reason of insufficient data [8-20]. The process of the study selection is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity analysis was conducted to find out the potential source of heterogeneity. Omitting the study of Barreto et al [8] decreased the heterogeneity to 0 ( p < 0.0001) and was considered a low heterogeneity among the studies. TSA of AHI showed that the Z -curve crossed the boundary of sufficiency indicating that we had sufficient information to confirm a significantly higher AHI in WUS patients (online suppl.…”

Section: Resultsmentioning

confidence: 99%

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Investigating the Association between Wake-Up Stroke and Obstructive Sleep Apnea: A Meta-Analysis

2021

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Background: Management of wake-up stroke (WUS) is always a challenge as no clear time of onset could be ascertained, and how to choose an appropriate therapy remains unclear. Sleep-disordered breathing (SDB) has been regarded as a potential risk factor to WUS, yet no consensus was achieved. Motivated by the need for a deeper understanding of WUS and its association with sleep apnea, meta-analyses summarizing the available evidence of respiratory events and indices were conducted, and sensitivity analysis was also used for heterogeneity. Methods: Electronic databases were systematically searched, and cross-checking was done for relevant studies. Collected data included demographic characteristics, and sleep apnea parameters were extracted with stroke patients divided into WUS and NWUS groups. Clinical data of stroke patients accompanied with sleep apnea syndrome (OSA, SAS, and severe SAS) were also extracted for meta-analysis. Results: A total of 13 studies were included in the analysis. The meta-analysis results showed that OSA, SAS, and severe SAS were significantly higher in WUS patients. A significantly higher AHI (WMD 7.74, 95% CI: 1.38–14.11; p = 0.017) and ODI (WMD of 3.85, 95% CI: 0.261–7.438; p = 0.035) than NWUS patients was also observed in the analysis of respiratory indices. Conclusion: WUS patients have severer SDB problems compared to NWUS patients suggesting that respiratory events during sleep might be underlying the induction of WUS. Besides, the induction of WUS was significantly associated with men rather than women. Therefore, early diagnosis and management of potential WUS patients should benefit from the detection of SDB status and respiratory effects.

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Section: Discussioncontrasting

confidence: 62%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Investigating the Association between Wake-Up Stroke and Obstructive Sleep Apnea: A Meta-Analysis

2021

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“… Score = 2; moderate; study design = 1 robust analyses = 1; others = 0. Barreto et al, 2020 [ 22 ] Brazil Prospective cohort study 102 (male = 64%) Ischemic stroke; hypertension; diabetes; heart disease; physical inactivity Wake-up stroke occurred in 1 of 3 of cases. Irrespective of stroke, half of the patients had moderate to severe sleep apnea.…”

Section: Methodsmentioning

confidence: 99%

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

2021

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Obstructive sleep apnea (OSA) is a serious, potentially life-threatening condition. Epidemiologic studies show that sleep apnea increases cardiovascular diseases risk factors including hypertension, obesity, and diabetes mellitus. OSA is also responsible for serious illnesses such as congestive heart failure, stroke, arrhythmias, and bronchial asthma. The aim of this systematic review is to evaluate evidence for the association between OSA and cardiovascular disease morbidities and identify risk factors for the conditions. In a review of 34 studies conducted in 28 countries with a sample of 37,599 people, several comorbidities were identified in patients with severe OSA—these were: heart disease, stroke, kidney disease, asthma, COPD, acute heart failure, chronic heart failure, hyperlipidemia, thyroid disease, cerebral infarct or embolism, myocardial infarction, and psychological comorbidities including stress and depression. Important risk factors contributing to OSA included: age > 35 years; BMI ≥ 25 kg/m2; alcoholism; higher Epworth sleepiness scale (ESS); mean apnea duration; oxygen desaturation index (ODI); and nocturnal oxygen desaturation (NOD). Severe OSA (AHI ≥ 30) was significantly associated with excessive daytime sleepiness and oxygen desaturation index. The risk of OSA and associated disease morbidities can be reduced by controlling overweight/obesity, alcoholism, smoking, hypertension, diabetes mellitus, and hyperlipidemia.

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“…Moreover, racial/ethnic minoritized populations have a higher rate of undiagnosed and untreated sleep apnea compared to their non-Hispanic White counterparts, with the same 2015 MESA study revealing that Chinese populations were 49% less likely to report a prior diagnosis of obstructive sleep apnea compared to non-Hispanic White populations despite their higher rates of obstructive sleep apnea via multiple objective measurements [ 3 ]. These observed disparities in obstructive sleep apnea are of particular concern because sleep apnea has been implicated in the pathogenic pathways of multiple conditions including diabetes [ 4 ], obesity [ 5 ], stroke [ 6 ], cardiovascular diseases [ 7 ], and all-cause mortality [ 8 ]. In particular, sleep apnea can increase the risk of developing obesity by potentially predisposing individuals to increased body fat percentages through leptin-mediated disrupted metabolism [ 9 ] and dysregulation in glucose levels [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of Sleep Apnea Is Associated with Abdominal Obesity Among Asian Americans: Comparing Waist-to-Hip Ratio and Body Mass Index

Lee

Ryu

Lee

et al. 2023

J. Racial and Ethnic Health Disparities

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Objective This study examines associations between the risk of sleep apnea and abdominal obesity (assessed by waist-to-hip ratio (WHR)) and general obesity (assessed by body mass index (BMI)) in a sample of Chinese and Korean American immigrants. Methods The dataset included Chinese and Korean participants aged 50–75 who were recruited from primary care physicians’ clinics from April 2018 to June 2020 in the Baltimore-Washington D.C. Metropolitan area ( n = 394). Abdominal obesity was determined if WHR ≥ 0.9 in men and WHR ≥ 0.85 in women. General obesity was determined if BMI ≥ 30. The risk of sleep apnea was determined by using the Berlin questionnaire. Poisson regression models examined associations between sleep apnea risk and obesity. Models controlled for socio-demographic risk factors. Results Twelve percent of the study participants were classified as a high risk for sleep apnea, and 75% had abdominal obesity whereas 6.4% had general obesity. High risk of sleep apnea was positively associated with abdominal obesity ( PR = 1.31, 95% CI: 1.17–1.47) and general obesity ( PR = 2.19, 95% CI: 0.90–5.32), marginally significant at p < 0.1). Conclusions Chinese and Korean immigrants living in the USA who are at high risk of sleep apnea have higher abdominal obesity, even after accounting for sociodemographic characteristics. Abdominal obesity may be a better indicator than general obesity when examining the risk of sleep apnea among Asian Americans. Information on Clinical Trial Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296; Date of registration: March 29, 2018 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1

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Obstructive Sleep Apnea and Wake-up Stroke – A 12 Months Prospective Longitudinal Study

Cited by 11 publications

References 33 publications

Investigating the Association between Wake-Up Stroke and Obstructive Sleep Apnea: A Meta-Analysis

Investigating the Association between Wake-Up Stroke and Obstructive Sleep Apnea: A Meta-Analysis

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

Risk of Sleep Apnea Is Associated with Abdominal Obesity Among Asian Americans: Comparing Waist-to-Hip Ratio and Body Mass Index

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