Prevalence of pre-stroke sleep apnea risk and short or long sleep duration in a bi-ethnic stroke population

Lott, Lindsey B. De; Lisabeth, Lynda D.; Sánchez, Brisa N.; Morgenstern, Lewis B.; Smith, Melinda A.; Garcia, Nelda; Chervin, Ronald D.; Brown, Devin L.

doi:10.1016/j.sleep.2014.09.007

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…First, the observed ethnic difference in SDB post stroke may reflect a difference that could predate stroke. Our group recently reported the results from administration of the Berlin questionnaire (used to assess high risk for SDB) in our stroke population in reference to the pre-stroke time period [31]. We found a nonsignificant higher odds of pre-stroke sleep apnea in MAs (61.9%) compared with NHWs (55.6%).…”

Section: Discussionmentioning

confidence: 87%

High prevalence of poststroke sleep-disordered breathing in Mexican Americans

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 87%

High prevalence of poststroke sleep-disordered breathing in Mexican Americans

et al. 2017

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“…Further, increased attention on reducing insomnia through cognitive behavior therapy, and the general recognition of the importance of sleep may improve non-SDB sleep disturbances. Sleep disturbances, while equally prevalent among different race/ethnic populations, 45 are more profoundly felt by the poor and minority groups due to these populations' more prevalent location in cities where noise, light and other impediments to sleep are more common.…”

Section: Resultsmentioning

confidence: 99%

Sleep and Stroke

Khot

Morgenstern

2019

Stroke

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Stroke is the leading cause of serious long-term disability in the US, leaving less than half of survivors able to return directly home. 1 Stroke recurrence, estimated as high as 17% over 5 years, also remains unacceptably high. 1 The use of lytic drugs and endovascular devices have revolutionized the care of select stroke patients in the acute setting. However, enormous challenges remain in changing the trajectory of stroke recovery for the vast majority of patients who do not qualify or remain disabled after these treatments, and also in preventing the accumulating disability associated with stroke recurrence. The role of sleep disorders in stroke outcome and recurrence has become a pressing question. Despite estimates of greater than 50% prevalence of sleep disorders after stroke, only about 6% of stroke survivors are offered formal sleep testing and an estimated 2% complete such testing in the 3-month post-stroke period. 2 The reasons for the low rate of screening are at least partly related to the lack of awareness regarding sleep disorders among stroke providers (Figure 1). This review evaluates the role of sleep disorders, including sleep disordered breathing (SDB) and sleep-wake cycle disorders, in stroke etiology and examines the impact of their treatment on stroke outcome. Physiology and anatomy of breathing during sleep During sleep, ventilation is reduced compared to wake, in parallel with the restorative and toning-down changes that occur to heart rate, temperature and blood pressure. Volitional or behavioral input on breathing are absent during sleep; only brainstem neurons, peripheral chemoreceptors and respiratory muscle afferents regulate breathing. 3 Groups of chemoreceptive neurons in the brainstem, including those of the dorsolateral pons, nucleus solitarius and ventral medullary respiratory column, respond to changes in the partial pressure of carbon dioxide and oxygen and thereby serve as a pacemaker regulating the breathing rhythm. 4 Along with effects on the breathing pattern, these brainstem neurons cause a reduction in the upper airway tone at sleep onset through reduced activity of airway dilator muscles, especially the genioglossus, which forms the bulk of the tongue. 3 Alternatively, the chemoreceptive neurons of the brainstem can detect increased carbon

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“…For example, in patients with acute strokes admitted to a tertiary stroke center, Hispanic/Latinos (mostly from Cuban descent) had a higher risk of sleep apnea (based on the Berlin questionnaire) than either black or white participants. 31 These findings were not reproduced by the Brain Attack Surveillance in Corpus Christi sleep apnea study, where prestroke sleep apnea risk did not differ between Hispanic/Latinos of Mexican descent and white participants, 32 but further studies are needed in other Hispanic groups and black patients.…”

Section: Prevalence and Risk Factors For Osa In Race-ethnic Minoritiesmentioning

confidence: 92%

Obstructive sleep apnea and stroke: links to health disparities

2015

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Obstructive sleep apnea (OSA) is a novel cardiovascular and cerebrovascular risk factor that presents unique opportunities to understand and reduce seemingly intractable stroke disparity among non-Hispanic blacks and Hispanic/Latinos. Individuals from these 2 groups have up to a 2-fold risk of stroke and greater burden of OSA. Obstructive sleep apnea directly and indirectly increases risk of stroke through a variety of autonomic, chemical, and inflammatory mechanisms and vascular risk factors such as hypertension, obesity, and diabetes mellitus. Untreated OSA exacerbates poststroke prognosis, as it may also influence rehabilitation efforts and functional outcomes such as cognitive function after a stroke. Conversely, treatment of OSA may reduce the risk of stroke and may yield better poststroke prognosis. Unfortunately, in racial/ethnic minority groups, there are limited awareness, knowledge, and screening opportunities for OSA. Increasing awareness and improving screening strategies for OSA in minorities may alleviate stroke risk burden and improve stroke outcomes in these populations. This review article is intended to highlight the epidemiology, clinical characteristics, pathophysiology, diagnosis, and treatment of OSA in relation to stroke risk, with an emphasis on race-ethnic disparities.

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Prevalence of pre-stroke sleep apnea risk and short or long sleep duration in a bi-ethnic stroke population

Cited by 7 publications

References 19 publications

High prevalence of poststroke sleep-disordered breathing in Mexican Americans

High prevalence of poststroke sleep-disordered breathing in Mexican Americans

Sleep and Stroke

Obstructive sleep apnea and stroke: links to health disparities

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