폐쇄수면무호흡증이 급성허혈뇌졸중의 기능적 회복에 미치는 영향
Effect of Obstructive Sleep Apnea on the Functional Outcome of Acute Ischemic Stroke
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Objectives: This study investigated the prevalence and clinical characteristics of obstructive sleep apnea (OSA) in acute ischemic stroke patients and the effect of OSA on prognosis of acute ischemic stroke. Methods: Forty-nine acute ischemic stroke patients with portable polysomnography (PSG) examination from 2017 to 2018 were included. Demographic data, laboratory findings, and PSG variables were collected. The severity of initial neurologic deficit was assessed using National Institutes of Health Stroke Scale (NIHSS) and functional outcome was evaluated using the modified Rankin Scale (mRS). An unfavorable prognosis three months after the onset of acute ischemic stroke was defined as an mRS ≥3. We assessed the association between with OSA severity and functional outcome using multivariate logistic regression. Results: Of 49 patients with acute ischemic stroke, 43 (87.8%) had OSA [apnea-hypopnea index (AHI)≥5/h]. Fourteen (28.6%) patients had mild OSA, 16 (32.7%) had moderate while 13 (26.5%) were having severe OSA. Univariate logistic regression showed that OSA related variables [AHI and oxygen desaturation index (ODI)] were associated with poor clinical outcome three months after stroke (mRS ≥3). Multivariate logistic regression analysis adjusted for age and initial NIHSS demonstrated that increase in AHI (adjusted odds ratio, 1.079; 95% confidence interval, 1.007–1.156, p=0.031) and ODI (adjusted odds ratio, 1.095; 95% confidence interval, 1.020–1.174, p=0.011) was associated with poor functional outcome three months after stroke. Conclusions: OSA in patients with acute ischemic stroke is associated with poor functional outcomes.
Abstract
Objectives: This study investigated the prevalence and clinical characteristics of obstructive sleep apnea (OSA) in acute ischemic stroke patients and the effect of OSA on prognosis of acute ischemic stroke. Methods: Forty-nine acute ischemic stroke patients with portable polysomnography (PSG) examination from 2017 to 2018 were included. Demographic data, laboratory findings, and PSG variables were collected. The severity of initial neurologic deficit was assessed using National Institutes of Health Stroke Scale (NIHSS) and functional outcome was evaluated using the modified Rankin Scale (mRS). An unfavorable prognosis three months after the onset of acute ischemic stroke was defined as an mRS ≥3. We assessed the association between with OSA severity and functional outcome using multivariate logistic regression. Results: Of 49 patients with acute ischemic stroke, 43 (87.8%) had OSA [apnea-hypopnea index (AHI)≥5/h]. Fourteen (28.6%) patients had mild OSA, 16 (32.7%) had moderate while 13 (26.5%) were having severe OSA. Univariate logistic regression showed that OSA related variables [AHI and oxygen desaturation index (ODI)] were associated with poor clinical outcome three months after stroke (mRS ≥3). Multivariate logistic regression analysis adjusted for age and initial NIHSS demonstrated that increase in AHI (adjusted odds ratio, 1.079; 95% confidence interval, 1.007–1.156, p=0.031) and ODI (adjusted odds ratio, 1.095; 95% confidence interval, 1.020–1.174, p=0.011) was associated with poor functional outcome three months after stroke. Conclusions: OSA in patients with acute ischemic stroke is associated with poor functional outcomes.
참고문헌 (33)
- Punjabi NM, "The epidemiology of adult obstructive sleep apnea", Proc Am Thorac Soc, 5, pp.136~143 (2008)
- Labarca G, "Multisystemic involvement in obstructive sleep apnea", Rev Med Chil, 142, pp.748~757 (2014)
- Maspero C, "Obstructive sleep apnea syndrome : a literature review", Minerva Stomatol, 64, pp.97~109 (2015)
- Hermann DM, "Sleep-related breathing and sleep-wake disturbances in ischemic stroke", Neurology, 73, pp.1313~1322 (2009)
- Arzt M, "Association of sleepdisordered breathing and the occurrence of stroke", Am J Respir Crit Care Med, 172, pp.1447~1451 (2015)
- Valham F, "Increased risk of stroke in patients with coronary artery disease and sleep apnea : a 10-year follow-up", Circulation, 118, pp.955~960 (2008)
- Peppard PE, "Prospective study of the association between sleep-disordered breathing and hypertension", N Engl J Med, 342, pp.1378~1384 (2000)
- Goyal SK, "Atrial fibrillation in obstructive sleep apnea", World J Cardiol, 5, pp.157~163 (2013)
- Colla-Machado PE, "Prevalence of silent cerebrovascular lesions in patients with obstructive sleep apnea syndrome", Rev Neurol, 62, pp.113~117 (2016)
- Bålfors EM, "Impairment of cerebral perfusion during obstructive sleep apneas", Am J Respir Crit Care Med, 150(6 Pt 1), pp.1587~1591 (1994)
- Diomedi M, "Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment", Neurology, 51, pp.1051~1056 (1998)
- Robbins J, "Associations of sleep-disordered breathing and cerebral changes on MRI", J Clin Sleep Med, 1, pp.159~165 (2005)
- Ciccone A, "Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: a cross-sectional study", Thorax, 68, pp.97~104 (2013)
- Lavergne F, "Atrial fibrillation and sleep-disordered breathing", J Thorac Dis, 7, pp.E575~E584 (2015)
- Sahlin C, "Obstructive sleep apnea is a risk factor for death in patients with stroke : a 10-year follow-up", Arch Intern Med, 168, pp.297~301 (2008)
- Parra O, "Sleep-related breathing disorders : impact on mortality of cerebrovascular disease", Eur Respir J, 24, pp.267~272 (2004)
- Turkington PM, "Effect of upper airway obstruction in acute stroke on functional outcome at 6months", Thorax, 59, pp.367~371 (2004)
- Good DC, "Sleep-disordered breathing and poor functional outcome after stroke", Stroke, 27, pp.252~259 (1996)
- Mansukhani MP, "Worse outcome after stroke in patients with obstructive sleep apnea : an observational cohort study", J Stroke Cerebrovasc Dis, 20, pp.401~405 (2011)
- Iranzo A, "Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction", Neurology, 58, pp.911~916 (2002)
- Menon D, "Impact of obstructive sleep apnea on neurological recovery after ischemic stroke : a prospective study", Acta Neurol Scand, 136, pp.419~426 (2017)
- Kernan WN, "Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2014, pp.45, 2160~2236
- Schulz H, "Phasic or transient? Comment on the terminology of the AASM manual for the scoring of sleep and associated events", J Clin Sleep Med, 3, pp.752~ (2007)
- Johnson KG, "Frequency of sleep apnea in stroke and TIA patients : a meta-analysis", J Clin Sleep Med, 6, pp.131~137 (2010)
- Cherkassky T, "Sleep-related breathing disorders and rehabilitation outcome of stroke patients : a prospective study", Am J Phys Med Rehabil, 82, pp.452~455 (2003)
- Camilo MR, "Sleep-disordered breathing among acute ischemic stroke patients in Brazil", Sleep Med, 19, pp.8~12 (2016)
- Selic C, "Blood pressure evolution after acute ischemic stroke in patients with and without sleep apnea", Stroke, 36, pp.2614~2618 (2005)
- Kryger M, "Principles and practice of sleep medicine" (2017), Elsevier
- Aaronson JA, "Effects of continuous positive airway pressure on cognitive and functional outcome of stroke patients with obstructive sleep apnea : a randomized controlled trial", J Clin Sleep Med, 12, pp.533~541 (2016)
- Ren L, "Effects of continuous positive airway pressure (CPAP) therapy on neurological and functional rehabilitation in Basal Ganglia Stroke patients with obstructive sleep apnea: a prospective multicenter study", Medicine (Baltimore), 98, pp.e16344~ (2019)
- Reutrakul S, "Obstructive sleep apnea and diabetes : a state of the art review", Chest, 152, pp.1070~1086 (2017)
- Hwu DW, "The association of obstructive sleep apnea and renal outcomes-a systematic review and meta-analysis", BMC Nephrol, 18, pp.313~ (2017)
- Tada T, "The predictors of central and obstructive sleep apnoea in haemodialysis patients", Nephrol Dial Transplant, 22, pp.1190~1197 (2007)