The coexistence of a patent foramen ovale and obstructive sleep apnea may increase the risk of wake-up stroke in young adults

Abstract

BACKGROUND: Patent foramen ovale (PFO) and obstructive sleep apnea (OSA) are independent risk factors for young conscious stroke which may also be concomitant symptoms with it. But there is no sufficient attention on these phenomena. OBJECTIVE: To investigate the relationship between PFO, OSA and young stroke, and to look for proper treatment. METHODS: Three patients with young conscious stroke were reported, each of them was combined with PFO and OSA. All patients were diagnosed as wake-up stroke (WUS). Contrast-enhanced transcranial doppler ultrasound (c-TCD) and polysomnography (PSG) test were used for auxiliary diagnosis. RESULTS: Right-to-left shunts and moderate to severe sleep apnea were observed. Increased body mass index (BMI), hemoglobin (HGB) and hematocrit (HCT) index were also observed. After continuous positive airway pressure (CPAP) therapy, the number of microbubbles was reduced in one patient. CONCLUSIONS: These suggest that coexistence of PFO and OSA may associate with a greater risk of youth stroke. Decrease risk of stroke might occur if treating with CPAP in patients with OSA.

Obstructive Sleep Apnea (OSA) and Patent Foramen Ovale (PFO), the “Perfect Storm” for a Cryptogenic Stroke? Case Series of Four Patients

“…These patients with stroke at a relatively young age had PFO and had severe OSA in REM sleep with prominent O 2 desaturation accompanied by heart rate elevation and electroencephalogram (EEG) arousals. Similar findings have been reported in a case series with three young patients with "wakeup" stroke with severe OSA (Man et al, 2019). Since the cases that we have described were seen over a span of several years, we have Spencer grading available in only the more recent cases as seen in patient 2.…”

“…The degree of desaturation during obstructive apneas tends to increase with those with RTLS compared to those without as seen with greater O 2 desaturation during Valsalva (Beelke et al, 2002;Virani et al, 2020). In a case series, patients with cryptogenic strokes and OSA were found to have severe hypoxemia (Man et al, 2019). It was also found that patients with OSA and PFO had significantly increased estimated pulmonary artery systolic pressure (32 vs. 22 mmHg) during Valsalva (Shanoudy et al, 1998;Beelke et al, 2002Beelke et al, , 2003.…”

Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors

“…Particularly in CS patients with PFO, elevated BMI and the presence of obstructive sleep apnea (OSA) might play a relevant role. Just recently, the coexistence of PFO and OSA in overweight men was suggested as a risk factor for wake-up stroke (47). Moreover, prolonged OSA episodes promoted RLS occurrence during sleep, which might increase the exposure time for paradoxical embolism (48).…”

Stroke: What's Sleep Got to Do With It?

“…Two articles have been published describing five patients with WUS who had moderate to severe OSA and patent foramen ovale (PFO). 56,57…”