Obstructive Sleep Apnea in Acute Stroke

Abstract

Background and Purpose— Sleep-disordered breathing is common among patients with stroke resulting in 4- to 6-fold higher prevalence of obstructive sleep apnea (OSA). We prospectively evaluated clinical characteristics and laboratory markers of inflammation and coagulability associated with OSA severity during the acute post stroke period. Methods— Consecutive patients admitted to the department of Neurology after an acute ischemic stroke were evaluated during the first 48 hours of symptom onset using Watch peripheral arterial tonometry, a wrist-worn ambulatory sleep study device that utilizes peripheral arterial tonometry. Morning blood samples of the patient were tested for tumor necrosis factor, interleukin-6, and plasminogen activator inhibitor-1 levels. Results— A total of 43 patients with acute stroke were admitted during the study period, 22 (51%) of which have been found to have moderate sleep apnea (apnea hypopnea index [AHI]≥15), AHI≥5 was found in 86% of the patients, and severe OSA (AHI≥30) in 32.5%. Patients with OSA (AHI≥15) did not differ from the rest in stroke severity or symptoms, yet they had higher prevalence of recurrent stroke and atrial fibrillation. All 3 biomarkers levels were higher among patients with AHI≥15: tumor necrosis factor (6.39 versus 3.57 pg/mL), interleukin-6 (6.64 versus 3.14 pg/mL), and plasminogen activator inhibitor-1 (176.64 versus 98.48 pg/mL). After the stratification of AHI into 3 groups (AHI<5, 5–14, and ≥15), the analysis showed that only the highest AHI group differed from the other 2 groups in biomarkers levels. Conclusions— Use of bed-side somnography technology revealed that in an unselected sample of patients with acute ischemic stroke, almost 90% had sleep-disordered breathing with third having severe form of the disorder. Sleep-disordered breathing was associated with significantly increased levels of inflammatory biomarkers, providing possible pathophysiological explanation of OSA-associated stroke risk. These results warrant prospective screening of patients with stroke for the presence of sleep-disordered breathing and lay the rationale for an interventional trial.

Tumor necrosis factor alpha is a promising circulating biomarker for the development of obstructive sleep apnea syndrome: a meta-analysis

“…After reviewing the title and abstract of each article, 99 were excluded for definitive reasons. After reading the full text of the rest 72 potential articles, 25 were further excluded, leaving 47 qualified articles in this meta-analysis according to the preset inclusive criteria [12–58]. Because 9 articles provided data by OSAS severity, 1 article by hypertension and 1 article by obesity, there were a total of 59 independent studies involving 2857 OSAS patients and 2115 controls in the final analysis.…”

“…Tumor necrosis factor alpha (TNF-alpha) is a key modulator of systematic inflammation [8–10], and TNF inhibition has proven to ameliorate the progression of OSAS [11]. Moreover, some researchers have observed a significant high level of circulating TNF-alpha in OSAS patients vis-à-vis healthy individuals [12–18], whereas others did not [19, 20]. The probable causes are multifaceted, relating to statistical power, research design, genetic heterogeneity or dietary habit.…”

Interactions between and Shared Molecular Mechanisms of Diabetic Peripheral Neuropathy and Obstructive Sleep Apnea in Type 2 Diabetes Patients

“…Increased PAI-1 activity was associated with sleep-disordered breathing, possibly contributing to increased vascular risk [ 167 ]. A previous study indicated that PAI-1 levels were significantly higher in OSA subjects than controls and PAI-1 positively correlated with AHI index [ 168 ].…”

Are symptoms of obstructive sleep apnoea related to good continuous positive airway pressure compliance?

“…Its prevalence in the general population in North America may be up to 30% in men and 15% in women [ 1 , 2 ]. Patients with untreated OSA are at increased risk for metabolic dysfunction, pulmonary hypertension, arrhythmias, fatal myocardial infarction, and ischaemic stroke [ 3 – 6 ]. The first-line treatment for OSA is continuous positive airway pressure (CPAP), good compliance with which can lead to better outcomes in areas such as quality of life and cardiovascular health [ 7 ].…”