High prevalence of poststroke sleep-disordered breathing in Mexican Americans

Abstract

Objective The purpose of this study is to compare sleep-disordered breathing (SDB) prevalence and severity after stroke between Mexican Americans (MAs) and non-Hispanic whites (NHWs). Patients/methods Ischemic stroke (IS) patients within ~30 days of onset were identified from the population-based BASIC Project (2010–2014) and offered screening with an overnight cardiopulmonary monitoring device, ApneaLink Plus™. The number of apneas and hypopneas per hour, as reflected by the apnea/hypopnea index (AHI), was used to measure SDB severity; SDB was defined as AHI ≥10. Ethnicity, demographics, and risk factors were collected from interviews and medical records. Log and negative-binomial regression models were used to determine prevalence ratios (PRs) and apnea/hypopnea event rate ratios (RRs) comparing MAs with NHWs after adjustment for demographics, risk factors, and stroke severity. Results A total of 549 IS cases had AHI data. The median age was 65 years (interquartile range (IQR): 57–76), 55% were men, and 65% were MA. The MAs had a higher prevalence of SDB (68.5%) than NHWs (49.5%) in unadjusted (PR = 1.38; 95% confidence interval (CI): 1.14–1.67) and adjusted analyses (PR = 1.21; 95% CI: 1.01–1.46). The median AHI was 16 (IQR: 7–31) in MAs and nine (IQR: 5–24) in NHWs. The severity of SDB (rate of apneas/hypopneas) was higher in MAs than NHWs in unadjusted (RR = 1.31; 95% CI: 1.09–1.58) but not adjusted analysis (RR = 1.14; 95% CI: 0.95–1.38). There was no ethnic difference in severity among subjects with SDB. Conclusion More than two-thirds of MA stroke patients had SDB, which was almost 40% more common among MAs than NHWs. Physicians treating MA patients after stroke should have a high index of suspicion for SDB, a treatable condition that could otherwise have adverse impact.

Sleep‐disordered breathing and poststroke outcomes

“…4 Pilot RCTs have evaluated the effect of CPAP on functional and cognitive outcomes, with mixed results. This association persisted despite comprehensive adjustment for confounding factors, and for potential selection bias.…”

“…4,40 Alternatively, downstream consequences of SDB may vary by ethnicity. The finding is not driven by ethnic differences in severity of SDB or in treatment of SDB poststroke based on our previous work.…”

“…Eligibility includes age ≥45 years, residence in Nueces County for ≥6 months per year, and stroke not as a result of trauma. 4,31 ApneaLink Plus results were provided to subjects after their 90-day outcome assessment. Exclusion criteria include current pregnancy or use of oxygen or positive pressure ventilation.…”

“…4 The limited epidemiologic data on the association between SDB and stroke outcomes have come primarily from small, singlehospital or rehabilitation-based studies. 4 The limited epidemiologic data on the association between SDB and stroke outcomes have come primarily from small, singlehospital or rehabilitation-based studies.…”

“…4,26 If SDB is associated with worse outcomes, then SDB may contribute to ethnic stroke outcome disparities and through its treatment offer a novel opportunity to reduce disparities. 4,26 If SDB is associated with worse outcomes, then SDB may contribute to ethnic stroke outcome disparities and through its treatment offer a novel opportunity to reduce disparities.…”