Association between the high risk for obstructive sleep apnea and intracranial carotid artery calcification in patients with acute ischemic stroke

Woo, Ho Geol; Song, Tae Jin; Jung, Jo Sung; Oh, Se Won; Lee, Seung Cheol; Seok, Jin Myoung; Yang, Kwang Ik

doi:10.1007/s11325-020-02117-x

Cited by 7 publications

(8 citation statements)

References 33 publications

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“…They stated that extracranial carotid artery calcification was observed in 38% of patients, intracranial carotid artery calcification was found in 43.8%, and the prevalence of intracranial carotid artery calcifications increased in the presence of extracranial carotid artery calcifications. Woo et al [ 13 ] studied the relationship between the OSA patients who had AHI > 30 (high-risk OSA patients) and intracranial carotid artery calcifications in patients with acute ischemic stroke using multidetector computed tomography. They used Berlin questionnaire for diagnosing OSA.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the intracranial carotid artery calcification reflects the overall handicap of cerebral atherosclerosis. Therefore, similar to the relationship between OSA and coronary artery calcification, intracranial carotid artery calcification might be related to OSA [ 13 ]. Harding et al [ 4 ] have shown that patients who experienced a stroke are 8–10 times more likely to show calcified carotid artery atheromas on their panoramic radiograph than healthy individuals.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Intracranial and Extracranial Carotid Artery Calcifications between Obstructive Sleep Apnea Patients and Healthy Individuals: A Combined Cone-Beam Computed Tomography and Polysomnographic Study

Firincioglulari

Aksoy

Orhan

et al. 2022

Radiology Research and Practice

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Purpose. This study aimed to compare the presence and grades of intra- and extracranial carotid artery calcifications between obstructive sleep apnea (OSA) and non-OSA patients. Methods. CBCT records of 190 patients (95 OSA patients and 95 non-OSA patients) were retrospectively collected and analyzed. Patient demographic data, including age and gender for both study groups and body mass index (BMI), and apnea-hypopnea index (AHI) for OSA patients were recorded. The presence of intra- and extracranial carotid artery calcifications and the number of calcifications were noted according to the grading scale. Results. There was a significant difference in carotid artery calcifications between OSA patients and healthy individuals. A total of 56.8% of the OSA patients showed at least one carotid artery calcification, whereas 13.8% of healthy individuals showed at least one carotid artery calcification ( p < 0.05 ). For intracranial calcifications, OSA patients showed a significantly higher prevalence than healthy individuals ( p < 0.05 ). The results showed that as the apnea-hypopnea index increases in OSA patients, the incidence of carotid artery calcification increases simultaneously. AHI > 30 patients showed the highest percentage of calcifications. Conclusion. In conclusion, OSA patients showed a higher prevalence of calcified carotid artery calcifications than healthy individuals. The results can be interpreted as the higher AHI, the more carotid artery calcification occurs. As these lesions can be a precursor of future strokes, 3D MDCT/CBCT images should evaluate meticulously not only extracranial but also intracranially, especially in OSA patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Intracranial and Extracranial Carotid Artery Calcifications between Obstructive Sleep Apnea Patients and Healthy Individuals: A Combined Cone-Beam Computed Tomography and Polysomnographic Study

Firincioglulari

Aksoy

Orhan

et al. 2022

Radiology Research and Practice

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“…In coronary artery disease studies, previous studies have demonstrated an association between OSA and increased coronary artery calcification (CAC), which is a surrogate marker for subclinical atherosclerosis [11][12][13][14]. So far, however, the association between OSA and vascular calcification in the intracranial arteries, both highly prevalent among older adults, has been investigated by very few studies [15]. To better understand the relation between OSA and cerebrovascular diseases, examining the association between OSA and subclinical cerebral atherosclerotic changes may be valuable.…”

Section: Introductionmentioning

confidence: 99%

Association between Obstructive Sleep Apnea and Intracranial Artery Calcification Stratified by Gender and Body Mass Index: A Hospital-Based Observational Study

Li,

Chen,

et al. 2023

Neuroepidemiology

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Background and Objectives: Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Furthermore, intracranial arterial calcification (IAC) has been validated as a marker for subclinical cerebrovascular disease. However, the relationship between OSA with IAC was less studied compared with its established association with coronary artery calcification. In this study, we aimed to investigate the association between the severity of OSA and the degree of IAC in hospitalized patients without preexisting cardiovascular disease. Methods: This hospital-based observational study was conducted from June 1, 2017, to May 1, 2019. In total, 901 consecutive patients who underwent head computed tomography scans and portable sleep monitoring were included. On the basis of the apnea-hypopnea index (AHI), patients were divided into four OSA severity groups (normal: AHI <5/h; mild: 5≤ AHI <15/h; moderate: 15≤ AHI <30/h; severe: AHI ≥30/h). Associations of OSA with IAC scores were assessed by using multivariate logistic regression analysis. Results: Of the 901 patients, 484 (53.7%) were men; the mean (SD) age was 66.1 (10.0) years. The non-OSA group included 207 (23.0%) patients; mild OSA, 209 (23.2%); moderate OSA, 235 (26.1%); and severe OSA, 169 (18.8%). Mean IAC scores were higher in the severe OSA group compared with non-, mild, and moderate OSA groups (4.79 vs. 2.58; 4.79 vs. 2.94; 4.79 vs. 3.39; p < 0.001). Multivariate analysis adjusted for confounding factors revealed that only severe OSA was associated with a higher IAC score (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.43–1.91; p < 0.001). In stratified analyses by BMI, among participants with a BMI <25 kg/m2, the positive association between AHI values and IAC scores was found in the moderate OSA group (OR: 1.23; 95% CI: 1.05, 1.43; p = 0.01) and the severe OSA group (OR: 1.96; 95% CI: 1.55, 2.48; p < 0.001). When stratified by gender, in women, the positive association was found in the moderate OSA group (adjusted OR: 1.21; 95% CI: 1.02–1.51; p = 0.016) and the severe OSA group (adjusted OR: 1.76; 95% CI: 1.36–2.25; p < 0.001). For the men group, a positive association between IAC scores and AHI was only observed in the severe OSA group. Discussion: These findings suggest that OSA, in particular severe OSA (AHI ≥30), is independently associated with higher IAC scores. Women and no-obesity individuals appeared more susceptible to adverse OSA-related subclinical cerebrovascular disease as measured by IAC scores.

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“…Several studies have shown that a high OSA-risk is associated with an increased risk of intracerebral hemorrhage ( 12 ), impaired cerebrovascular reactivity ( 13 ), and presence of intracranial carotid artery calcification ( 14 ) after stroke. OSA and CSVD may share similar pathophysiological mechanisms via common vascular risk factors, such as hypertension.…”

Section: Introductionmentioning

confidence: 99%

Associations of sleep apnea risk and oxygen desaturation indices with cerebral small vessel disease burden in patients with stroke

Lam

Mak

et al. 2022

Front. Neurol.

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BackgroundObstructive sleep apnea (OSA) is associated with cerebral small vessel disease (CSVD). Nonetheless, whether OSA-risk determined by a simple screening questionnaire or indices quantifying nocturnal hypoxemia other than the conventional apnea–hypopnea index (AHI) by the home sleep apnea test (HSAT) associated with CSVD burden remains uncertain.MethodsFrom 2018 to 2021, we recruited patients with transient ischemic attack (TIA)/minor stroke from the Queen Mary Hospital Acute Stroke Unit and TIA/Stroke Outpatient Clinics. Logistic regression models were applied to determine the association of baseline OSA-risk (on STOP-BANG questionnaire) or HSAT-derived indices quantifying nocturnal hypoxemia with global burden/individual markers of CSVD on MRI. Indices included oxygen desaturation (≥3%) index (ODI), minimum oxygen saturation (SpO2), percentage of total sleep time with an oxygen saturation <90% (CT90%), and desaturation duration (≥3%, DesDur).ResultsIn 283 patients with TIA/minor stroke (mean age 65 years, 64% men), OSA-risk was significantly associated with total CSVD score (multivariate-adjusted odds ratio: 1.23, 95% confidence interval 1.01–1.51), presence of lacunes [1.39 (1.09–1.79)] and burden of basal ganglia PVSs [1.32 (1.06–1.67)]. In 85/283 patients who completed HSAT, neither AHI, minimum SpO2 nor CT90% was associated with CSVD burden. Nonetheless, ODI and DesDur remained significantly associated with total CSVD score after covariate adjustment: ODI [1.04 (1.01–1.07)] and DesDur [1.04 (1.01–1.08)].ConclusionIn patients with TIA/minor stroke, high OSA-risk was associated with a greater CSVD burden. Oxygen desaturation indices (ODI and DesDur) rather than AHI were independently associated with global CSVD burden, indicating that longer and more severe desaturations may contribute to the pathogenesis of CSVD.

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Association between the high risk for obstructive sleep apnea and intracranial carotid artery calcification in patients with acute ischemic stroke

Cited by 7 publications

References 33 publications

Comparison of Intracranial and Extracranial Carotid Artery Calcifications between Obstructive Sleep Apnea Patients and Healthy Individuals: A Combined Cone-Beam Computed Tomography and Polysomnographic Study

Comparison of Intracranial and Extracranial Carotid Artery Calcifications between Obstructive Sleep Apnea Patients and Healthy Individuals: A Combined Cone-Beam Computed Tomography and Polysomnographic Study

Association between Obstructive Sleep Apnea and Intracranial Artery Calcification Stratified by Gender and Body Mass Index: A Hospital-Based Observational Study

Associations of sleep apnea risk and oxygen desaturation indices with cerebral small vessel disease burden in patients with stroke

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