scholarly journals 0569 Screening for Obstructive Sleep Apnea in Patients with Ischemic Stroke and Transient Ischemic Attack

SLEEP ◽  
2018 ◽  
Vol 41 (suppl_1) ◽  
pp. A212-A212
Author(s):  
A Metzler ◽  
D Lindsay ◽  
M Irfan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Obstructive Sleep ◽  
Ischemic Attack

scholarly journals Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

2020 ◽  
Vol 24 (4) ◽  
pp. 1495-1505 ◽  
Author(s):  
Akseli Leino ◽  
Susanna Westeren-Punnonen ◽  
Juha Töyräs ◽  
Sami Myllymaa ◽  
Timo Leppänen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Sleep Disordered Breathing ◽  
Apnea Hypopnea Index ◽  
Stroke Patients ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Ischemic Attack

Abstract Purpose Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing. Methods Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients. Results Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients. Conclusion Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA.

scholarly journals “Wakeup” to Reality!

2019 ◽  
pp. 488-500
Author(s):  
Madeleine Grigg-Damberger
Keyword(s):  
Older Adults ◽  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Epworth Sleepiness Scale ◽  
Severe Obstructive Sleep Apnea ◽  
Younger Adults ◽  
Obstructive Sleep ◽  
Ischemic Attack

A small-vessel left paramedian pontine ischemic infarction on awakening from sleep in a 74-year-old woman with hypercholesterolemia triggered an evaluation for untreated severe obstructive sleep apnea (OSA). This case illustrates how the clinical presentation of OSA is different in older and younger adults. Older adults with OSA are more likely to report not feeling well rested in the morning, to have higher scores on the Epworth Sleepiness Scale, and to have greater frequency of nocturia. It is important to consider untreated OSA in patients who have ischemic stroke on awakening from sleep. Most strokes occur between 6 a.m. and noon, but strokes during sleep warrant consideration of untreated OSA. OSA is highly prevalent in patients after stroke or transient ischemic attack. OSA is associated with poorer outcomes after ischemic strokes.

scholarly journals Sleep for Stroke Management and Recovery Trial (Sleep SMART): Rationale and methods

2020 ◽  
Vol 15 (8) ◽  
pp. 923-929 ◽  
Author(s):  
Devin L Brown ◽  
Valerie Durkalski ◽  
Jeffrey S Durmer ◽  
Joseph P Broderick ◽  
Darin B Zahuranec ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Acute Ischemic Stroke ◽  
Functional Recovery ◽  
Transient Ischemic Attack ◽  
Stroke Management ◽  
Vascular Events ◽  
Obstructive Sleep ◽  
Ischemic Attack

Rationale Obstructive sleep apnea is common among patients with acute ischemic stroke and is associated with reduced functional recovery and an increased risk for recurrent vascular events. Aims and/or hypothesis The Sleep for Stroke Management and Recovery Trial (Sleep SMART) aims to determine whether automatically adjusting continuous positive airway pressure (aCPAP) treatment for obstructive sleep apnea improves clinical outcomes after acute ischemic stroke or high-risk transient ischemic attack. Sample size estimate A total of 3062 randomized subjects for the prevention of recurrent serious vascular events, and among these, 1362 stroke survivors for the recovery outcome. Methods and design Sleep SMART is a phase III, multicenter, prospective randomized, open, blinded outcome event assessed controlled trial. Adults with recent acute ischemic stroke/transient ischemic attack and no contraindication to aCPAP are screened for obstructive sleep apnea with a portable sleep apnea test. Subjects with confirmed obstructive sleep apnea but without predominant central sleep apnea proceed to a run-in night of aCPAP. Subjects with use (≥4 h) of aCPAP and without development of significant central apneas are randomized to aCPAP plus usual care or care-as-usual for six months. Telemedicine is used to monitor and facilitate aCPAP adherence remotely. Study outcomes Two separate primary outcomes: (1) the composite of recurrent acute ischemic stroke, acute coronary syndrome, and all-cause mortality (prevention) and (2) the modified Rankin scale scores (recovery) at six- and three-month post-randomization, respectively. Discussion Sleep SMART represents the first large trial to test whether aCPAP for obstructive sleep apnea after stroke/transient ischemic attack reduces recurrent vascular events or death, and improves functional recovery.

scholarly journals Association between obstructive sleep apnea and ischemic stroke etiology

2021 ◽  
Author(s):  
Ana Claudia Crispiniano Siqueira Torquato ◽  
Silvana Sobreira Santos ◽  
Rodrigo Pinto Pedrosa
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Elderly Population ◽  
Management Strategies ◽  
Obstructive Sleep ◽  
The Mean ◽  
One Year ◽  
Ischemic Attack ◽  
Toast Classification

Introduction: Stroke is a potentially disabling event, therefore determining its etiology is the key in the development of management strategies to reduce the risk of a new event and costs. Obstructive sleep apnea (OSA) is common in stroke and is an independent risk factor. The objective of this study was to determine the association between the etiology of ischemic stroke and the presence of OSA. Methods: Observational, descriptive, patients with ischemic stroke or acute transient ischemic attack (TIA) in the Hospital Memorial São José and Hospital Esperança Recife-PE for one year, the etiology of stroke was categorized by TOAST classification and portable polysomnography for diagnosis of OSA. Results: 100 patients analyzed, 81 ischemic strokes and 19 TIA. The prevalence OSA (AHI≥15) was 51%. The mean age of the sample was 67.9±14.6 years, with older OSA patients (70.0±14.2 vs 65.6±14.7, p=0.128). There was a higher occurrence of females, DM, dyslipidemia and previous ictus in patients with OSA (p=0.052 /0.008 /0.055 /0.018, respectively). BMI was 27.22±4.3kg/m² in patients without OSA and 28.05±3.8kg/m² among patients with OSA. There was no association between the etiological subtype of ictus and the presence of OSA (p=0.698). Conclusions: Our study included an elderly population with a higher frequency of dyslipidemia, DM and previous ictus in patients with OSA, but it was not possible to establish a relationship between the etiology of the stroke and the presence of OSA.

P3797Increased risk of cardiovascular events and stroke among patients with atrial fibrillation and obstructive sleep apnea

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Dalgaard ◽  
R North ◽  
K Pieper ◽  
B A Steinberg ◽  
K W Mahaffey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Chronic Obstructive ◽  
Adjusted Risk ◽  
Obstructive Sleep ◽  
Ischemic Attack

Abstract Background Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). It is not well understood if OSA impacts cardiovascular outcomes in patients with AF. Purpose To investigate patient characteristics and major adverse cardiovascular and neurological events (MACNE) in patients with AF and OSA. Methods Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF I) and ORBIT-AF II we compared the adjusted risk of the composite of cardiovascular death, myocardial infarction, stroke/transient ischemic attack/non-CNS embolism (stroke/SE), and new-onset heart failure (MACNE) according to the presence or absence of OSA, using multivariable adjusted Cox proportional hazard models. Secondary outcomes were the individual components of MACNE. Results Among 22,760 patients with AF, there were 4,045 (17.8%) with OSA at baseline. Median follow-up time was 1.5 (IQR: 1–2.2) years. OSA patients were younger (median [IQR] 68 [61–75] years vs. 74 [66–81] years, were more likely to be male (70.7% vs. 55.3%), and had markedly increased body mass index (BMI) (median 34.6 kg/m2 [29.8–40.2] vs. 28.7 kg/m2 [25.2–33.0]). Those with OSA had a higher prevalence of diabetes (39.2% vs. 25.2%), chronic obstructive pulmonary disease (COPD) (20% vs. 12%), heart failure (32.2% vs. 25.1%), and hyperlipidemia (73.2% vs. 66.7%). After adjustment, the presence of OSA was significantly associated with MACNE (HR: 1.16 [95% CI: 1.03–1.31], p=0.011) [Figure]. Stroke/SE was higher in patients with OSA (HR: 1.38 [95% CI 1.12–1.70], p=0.003). Addition of OSA to a model containing the CHA2DS2-VASc risk factors slightly improved discrimination for stroke/SE: CHA2DS2-VASc risk factors alone C-index (Standard Error) was 0.6867 (0.0125) vs. CHA2DS2-VASc risk factors plus OSA 0.6876 (0.0124), p=0.022. Figure 1. Hazard ratios with 95% confidence intervals and event rates for the association between obstructive sleep apnea and major adverse cardiovascular and neurological events combined and separately. Abbreviations: OSA; obstructive sleep apnea MACNE; major adverse cardiovascular and neurological events, CV; cardiovascular, TIA; transient ischemic attack. Conclusion One in five patients with AF in community practice had OSA. The presence of OSA was associated with higher risk of MACNE and stroke/SE. Addition of OSA to CHA2DS2-VASc risk factors only slightly improved discrimination for the occurrence of stroke. Acknowledgement/Funding The Danish Heart Foundation, T32 NIH Grant HL079896. The ORBIT-AF registry is sponsored by Janssen.

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