Sonja G Schütz1, Lynda D Lisabeth2, River Gibbs3, Xu Shi4, Erin Case5, Ronald D Chervin6, Devin L Brown7. 1. Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address: schuetzs@umich.edu. 2. Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Stroke Program - Cardiovascular Center, Department of Neurology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address: llisabet@umich.edu. 3. Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Electronic address: rivgibbs@umich.edu. 4. Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Electronic address: shixu@umich.edu. 5. Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Electronic address: erincase@med.umich.edu. 6. Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address: chervin@med.umich.edu. 7. Stroke Program - Cardiovascular Center, Department of Neurology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address: devinb@umich.edu.
Abstract
OBJECTIVE/ BACKGROUND: Obstructive sleep apnea is a risk factor for stroke. This study sought to assess the relationship between obstructive sleep apnea (OSA) and wake-up strokes (WUS), that is, stroke symptoms that are first noted upon awakening from sleep. PATIENTS/ METHODS: In this analysis, 837 Brain Attack Surveillance in Corpus Christi (BASIC) project participants completed an interview to ascertain stroke onset during sleep (WUS) versus wakefulness (non-wake-up stroke, non-WUS). A subset of 316 participants underwent a home sleep apnea test (HSAT) shortly after ischemic stroke to assess for OSA. Regression models were used to test the association between OSA and WUS, stratified by sex. RESULTS: Of 837 participants who completed the interview, 251 (30%) reported WUS. Among participants who underwent an HSAT, there was no significant difference in OSA severity [respiratory event index (REI)] among participants with WUS [median REI 17, interquartile range (IQR) 10, 29] versus non-WUS (median REI 18, IQR 9, 30; p = 0.73). OSA severity was not associated with increased odds of WUS among men [unadjusted odds ratio (OR) 1.011, 95% confidence interval (95% CI) 0.995, 1.027] or women (unadjusted OR 0.987, 95% CI 0.959, 1.015). These results remained unchanged after adjustment for age, congestive heart failure, body mass index, and pre-stroke depression in men (adjusted OR 1.011, 95% CI 0.994, 1.028) and women (adjusted OR 0.988, 95% CI 0.959, 1.018). CONCLUSIONS: Although OSA is a risk factor for stroke, the onset of stroke during sleep is not associated with OSA in this large, population-based stroke cohort.
OBJECTIVE/ BACKGROUND: Obstructive sleep apnea is a risk factor for stroke. This study sought to assess the relationship between obstructive sleep apnea (OSA) and wake-up strokes (WUS), that is, stroke symptoms that are first noted upon awakening from sleep. PATIENTS/ METHODS: In this analysis, 837 Brain Attack Surveillance in Corpus Christi (BASIC) project participants completed an interview to ascertain stroke onset during sleep (WUS) versus wakefulness (non-wake-up stroke, non-WUS). A subset of 316 participants underwent a home sleep apnea test (HSAT) shortly after ischemic stroke to assess for OSA. Regression models were used to test the association between OSA and WUS, stratified by sex. RESULTS: Of 837 participants who completed the interview, 251 (30%) reported WUS. Among participants who underwent an HSAT, there was no significant difference in OSA severity [respiratory event index (REI)] among participants with WUS [median REI 17, interquartile range (IQR) 10, 29] versus non-WUS (median REI 18, IQR 9, 30; p = 0.73). OSA severity was not associated with increased odds of WUS among men [unadjusted odds ratio (OR) 1.011, 95% confidence interval (95% CI) 0.995, 1.027] or women (unadjusted OR 0.987, 95% CI 0.959, 1.015). These results remained unchanged after adjustment for age, congestive heart failure, body mass index, and pre-stroke depression in men (adjusted OR 1.011, 95% CI 0.994, 1.028) and women (adjusted OR 0.988, 95% CI 0.959, 1.018). CONCLUSIONS: Although OSA is a risk factor for stroke, the onset of stroke during sleep is not associated with OSA in this large, population-based stroke cohort.
Authors: Tetyana Kendzerska; Richard S Leung; Clare L Atzema; George Chandy; Moussa Meteb; Atul Malhotra; Gillian A Hawker; Andrea S Gershon Journal: Sleep Med Date: 2019-09-11 Impact factor: 3.492
Authors: Devin L Brown; Ashkan Mowla; Mollie McDermott; Lewis B Morgenstern; Garnett Hegeman; Melinda A Smith; Nelda M Garcia; Ronald D Chervin; Lynda D Lisabeth Journal: J Stroke Cerebrovasc Dis Date: 2014-12-10 Impact factor: 2.136
Authors: Lewis B Morgenstern; Melinda A Smith; Brisa N Sánchez; Devin L Brown; Darin B Zahuranec; Nelda Garcia; Kevin A Kerber; Lesli E Skolarus; William J Meurer; James F Burke; Eric E Adelman; Jonggyu Baek; Lynda D Lisabeth Journal: Ann Neurol Date: 2013-08-13 Impact factor: 10.422
Authors: Liming Dong; Devin L Brown; Ronald D Chervin; Erin Case; Lewis B Morgenstern; Lynda D Lisabeth Journal: Sleep Med Date: 2020-05-11 Impact factor: 3.492
Authors: Devin L Brown; Chengwei Li; Ronald D Chervin; Erin Case; Nelda M Garcia; Susan D Tower; Lynda D Lisabeth Journal: Neurol Clin Pract Date: 2018-02