Increased Risk of Ischemic Stroke during Sleep in Apneic Patients
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Background and Purpose The literature indicates that obstructive sleep apnea (OSA) increasesthe risk of ischemic stroke. However, the causal relationship between OSA and ischemicstroke is not well established. This study examined whether preexisting OSA symptomsaffect the onset of acute ischemic stroke. Methods We investigated consecutive patients who were admitted with acute ischemicstroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSAprior to stroke. The collected stroke data included the time of the stroke onset, risk factors, andetiologic subtypes. The association between preceding OSA symptoms and wake-up stroke(WUS) was assessed using multivariate logistic regression analysis. Results We identified 260 subjects with acute ischemic strokes with a definite onset time, ofwhich 25.8% were WUS. The presence of preexisting witnessed or self-recognized sleep apneawas the only risk factor for WUS (adjusted odds ratio=2.055, 95% confidence interval=1.035–4.083, p=0.040). Conclusions Preexisting symptoms suggestive of OSA were associated with the occurrence ofWUS. This suggests that OSA contributes to ischemic stroke not only as a predisposing risk factorbut also as a triggering factor. Treating OSA might therefore be beneficial in preventingstroke, particularly that occurring during sleep.
Abstract
Background and Purpose The literature indicates that obstructive sleep apnea (OSA) increasesthe risk of ischemic stroke. However, the causal relationship between OSA and ischemicstroke is not well established. This study examined whether preexisting OSA symptomsaffect the onset of acute ischemic stroke. Methods We investigated consecutive patients who were admitted with acute ischemicstroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSAprior to stroke. The collected stroke data included the time of the stroke onset, risk factors, andetiologic subtypes. The association between preceding OSA symptoms and wake-up stroke(WUS) was assessed using multivariate logistic regression analysis. Results We identified 260 subjects with acute ischemic strokes with a definite onset time, ofwhich 25.8% were WUS. The presence of preexisting witnessed or self-recognized sleep apneawas the only risk factor for WUS (adjusted odds ratio=2.055, 95% confidence interval=1.035–4.083, p=0.040). Conclusions Preexisting symptoms suggestive of OSA were associated with the occurrence ofWUS. This suggests that OSA contributes to ischemic stroke not only as a predisposing risk factorbut also as a triggering factor. Treating OSA might therefore be beneficial in preventingstroke, particularly that occurring during sleep.
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