J Clin Neurol.  2018 Apr;14(2):174-178. 10.3988/jcn.2018.14.2.174.

Increased Risk of Ischemic Stroke during Sleep in Apneic Patients

• Kim JS
• Kim S
• Lee SH
• Lee HY
• Lee SY
• Im KB

• KMID: 2407943
• DOI: http://doi.org/10.3988/jcn.2018.14.2.174

Abstract

BACKGROUND AND PURPOSE
The literature indicates that obstructive sleep apnea (OSA) increases the risk of ischemic stroke. However, the causal relationship between OSA and ischemic stroke is not well established. This study examined whether preexisting OSA symptoms affect the onset of acute ischemic stroke.
METHODS
We investigated consecutive patients who were admitted with acute ischemic stroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSA prior to stroke. The collected stroke data included the time of the stroke onset, risk factors, and etiologic 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, of which 25.8% were WUS. The presence of preexisting witnessed or self-recognized sleep apnea was 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 of WUS. This suggests that OSA contributes to ischemic stroke not only as a predisposing risk factor but also as a triggering factor. Treating OSA might therefore be beneficial in preventing stroke, particularly that occurring during sleep.

Keyword

obstructive sleep apnea; wake-up stroke; questionnaires

MeSH Terms

Berlin
Humans
Logistic Models
Risk Factors
Sleep Apnea Syndromes
Sleep Apnea, Obstructive
Stroke*

Figure

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  Fig. 1 Study subjects. WUS: wake-up stroke.

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