Stephanie M Stahl1, H Klar Yaggi2, Stanley Taylor3, Li Qin4, Cristina S Ivan5, Charles Austin6, Jared Ferguson7, Radu Radulescu8, Lauren Tobias8, Jason Sico9, Carlos A Vaz Fragoso8, Linda S Williams10, Rachel Lampert8, Edward J Miech11, Marianne S Matthias12, John Kapoor13, Dawn M Bravata14. 1. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. Electronic address: Stephanie.Stahl@va.gov. 2. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA. 3. Department of Biostatistics, Indiana University School of Medicine, IUPUI, Indianapolis, IN 46202, USA. 4. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06520, USA. 5. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. 6. VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. 7. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA. 8. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA. 9. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA. 10. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA. 11. VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. 12. VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA; Department of Communication Studies, Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN 46202, USA. 13. Chicago Medical School, North Chicago, IL 60064, USA. 14. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA.
Abstract
BACKGROUND: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. METHODS: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. RESULTS: Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. CONCLUSIONS: These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients. Published by Elsevier B.V.
BACKGROUND: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic strokepatients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. METHODS: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. RESULTS: Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. CONCLUSIONS: These results indicate that OSA is present in the majority of strokepatients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic strokepatients. Published by Elsevier B.V.
Authors: Stefan T Kotzian; Judith K Stanek; Michaela M Pinter; Wilfried Grossmann; Michael T Saletu Journal: Top Stroke Rehabil Date: 2012 Jan-Feb Impact factor: 2.119
Authors: H Klar Yaggi; John Concato; Walter N Kernan; Judith H Lichtman; Lawrence M Brass; Vahid Mohsenin Journal: N Engl J Med Date: 2005-11-10 Impact factor: 91.245
Authors: Devin L Brown; Lynda D Lisabeth; Michael J Zupancic; Maryann Concannon; Cory Martin; Ronald D Chervin Journal: Stroke Date: 2008-07-10 Impact factor: 7.914
Authors: Jason J Sico; H Klar Yaggi; Susan Ofner; John Concato; Charles Austin; Jared Ferguson; Li Qin; Lauren Tobias; Stanley Taylor; Carlos A Vaz Fragoso; Vincent McLain; Linda S Williams; Dawn M Bravata Journal: J Stroke Cerebrovasc Dis Date: 2017-04-14 Impact factor: 2.136
Authors: Benjamin K Petrie; Tudor Sturzoiu; Julie Shulman; Saleh Abbas; Hesham Masoud; Jose Rafael Romero; Tatiana Filina; Thanh N Nguyen; Helena Lau; Judith Clark; Sanford Auerbach; Yelena G Pyatkevich; Hugo J Aparicio Journal: J Clin Med Date: 2021-08-13 Impact factor: 4.241
Authors: Elie Gottlieb; Leonid Churilov; Emilio Werden; Thomas Churchward; Matthew P Pase; Natalia Egorova; Mark E Howard; Amy Brodtmann Journal: J Clin Sleep Med Date: 2021-02-01 Impact factor: 4.062
Authors: Anna Lena Fisse; André Kemmling; Anja Teuber; Heike Wersching; Peter Young; Ralf Dittrich; Martin Ritter; Rainer Dziewas; Jens Minnerup Journal: PLoS One Date: 2017-01-30 Impact factor: 3.240