Abstract TP209: Time Of Stroke Onset Is Not Associated With Risk Of Obstructive Sleep Apnea In Intracerebral Hemorrhage.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jennifer Rose V Molano ◽  
Sebastian Koch ◽  
Carl Langefeld ◽  
Daniel Woo
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Stroke Onset ◽  
Berlin Questionnaire ◽  
Risk Status ◽  
Nocturnal Blood Pressure ◽  
Obstructive Sleep

Objective: To test the hypothesis that risk status for obstructive sleep apnea (OSA) is associated with time of onset in intracerebral hemorrhage. Background: OSA can affect 30-70% of patients with ischemic strokes, intracerebral hemorrhage and transient ischemic attacks. In normal sleep, blood pressure and heart rate decrease due to increased parasympathetic activity. In OSA, increased sympathetic activity during sleep can lead to a absence of this blood pressure fall. This non-dipping nocturnal blood pressure pattern has been associated with a shift in the timing of sudden cardiac death, from 7am-noon in those without OSA to 12am-6am in those with OSA. Whether this diurnal shift exists in intracerebral hemorrhage cases at high risk for OSA has not been studied. Method: A nested case control study within the interviewed case cohort from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study was performed. OSA risk status was categorized as “high-risk” based on a positive score in 2 out of 3 categories on the Berlin questionnaire, which ascertains snoring, daytime fatigue, body mass index and hypertension. Timing of intracerebral hemorrhage was categorized as “Nocturnal” based on a known time of stroke onset from 22:00pm to 06:00am and “Awake” based on a known time of stroke onset from 06:01am to 21:59pm. Results: Time of stroke onset was known in 434 subjects. The Berlin questionnaire categorized 54.2% of cases as high-risk for OSA. In comparison with low-risk subjects, high-risk cases tended to be younger (59.1±13.7 vs. 61.8±15.7, p=0.05), male (48% vs 58%, p=0.03), have coronary disease (6% vs 11%, p=0.09), have diabetes (27% vs 18%, p=0.02), and have dyslipidemia (43% vs 30%, p=0.006). There were no ethnic differences in the prevalence of high risk for OSA (P=0.60). Nocturnal strokes were seen in 17% of high- and low-risk OSA cases. There was no statistically significant difference in OSA status and timing of stroke (p=0.98). Conclusions: OSA risk status was not associated with timing of hemorrhagic stroke. This finding suggests that a non-dipping nocturnal blood pressure pattern is not seen in intracerebral hemorrhage cases at high-risk for OSA.

Abstract TP347: Obstructive Sleep Apnea Frequency in Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jacqueline H Geer ◽  
Audrey C Leasure ◽  
Kevin N Vanent ◽  
Lauren H Sansing ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Berlin Questionnaire ◽  
Established Risk Factor ◽  
Obstructive Sleep ◽  
History Of

Introduction: Obstructive sleep apnea (OSA) is a treatable condition and well-established risk factor for ischemic stroke, but the prevalence in ICH is unknown. We aim to characterize the frequency of OSA in spontaneous intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective observational study evaluating risk factors for ICH among whites, blacks, and Hispanics. OSA status was determined using two different strategies: (1) the Berlin Questionnaire, a validated screening tool to identify those with a high likelihood of OSA where “high risk” is defined as > 1 point in at least 2 of 3 categories assessing snoring, fatigue, and hypertension, and (2) self-reported history of diagnosed sleep apnea. Results: We evaluated 3000 ICH cases. Within this group, 2896 (96.5%) completed the Berlin questionnaire, with 2064 (71%) patients being high risk for OSA. Compared to patients with low risk of OSA, those at high risk were more likely to be male (61% versus 53%, p<0.001) with hypertension (93% versus 65%, p<0.001), diabetes (32% versus 20%, p<0.001), hyperlipidemia (49% versus 38%, p<0.001), and higher BMI (29.8 +/- 8.1 versus 26.8 +/- 6.5, p<0.001), and less likely to have lobar ICH location (29% versus 35%, p<0.001). Self-reported history of prior sleep apnea diagnosis was present in only 175 (9.5%) of ICH cases. Conclusions: OSA is highly prevalent and underdiagnosed in our cohort of ICH patients. Given the effective treatments available for OSA, which have been shown to improve morbidity and mortality in patients with ischemic stroke, further studies are needed to assess the role of OSA as both a determinant of both risk and outcome in ICH.

scholarly journals High risk for obstructive sleep apnea in patients with acute myocardial infarction

2015 ◽  
Vol 23 (5) ◽  
pp. 797-805
Author(s):  
Carla Renata Silva Andrechuk ◽  
Maria Filomena Ceolim
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Berlin Questionnaire ◽  
Obstructive Sleep ◽  
Modifiable Factors ◽  
Tertiary Teaching ◽  
Clinical Worsening

Objectives: to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.Method: cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male). A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.Results: the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over) constituted a protective factor.Conclusion: considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

High Risk for Obstructive Sleep Apnea in Truck Drivers Estimated by the Berlin Questionnaire: Prevalence and Associated Factors

2004 ◽  
Vol 21 (6) ◽  
pp. 871-879 ◽  
Author(s):  
C. R. C. Moreno ◽  
F. A. Carvalho ◽  
C. Lorenzi ◽  
L. S. Matuzaki ◽  
S. Prezotti ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Associated Factors ◽  
Truck Drivers ◽  
Berlin Questionnaire ◽  
Obstructive Sleep

scholarly journals Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural Population

2012 ◽  
Vol 19 (1) ◽  
pp. 7-16
Author(s):  
Otilia Niţă ◽  
Lidia Graur ◽  
Dana Popescu ◽  
Alina Popa ◽  
Laura Mihalache ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Obstructive Sleep Apnea Syndrome ◽  
Rural Population ◽  
Sleep Apnea Syndrome ◽  
Berlin Questionnaire ◽  
Height Ratio ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural PopulationObjective. To evaluate which anthropometric parameter better predicts the high risk of obstructive sleep apnea syndrome (OSA) in a rural population. Material and Method. 254 subjects were enrolled. We measured weight, height, waist circumference (WC) and neck circumference (NC) and calculated body mass index (BMI), waist-to-height ratio (WHtR) and neck circumference/height ratio (NC/Height). The risk of OSA was assessed by using Berlin Questionnaire. Results. Subjects with high risk of OSA had a significant higher BMI, WC, WHtR, NC, and NC/Height. A higher percentage of those with large WC (≥80cm and ≥94cm for women and men, respectively) (p<0.001), WHtR ≥0.5 (p<0.001), NC ≥40cm (p=0.004), NC/Height ratio ≥0.23 (p=0.002) had a high risk of OSA. Using ROC curves of anthropometric parameters studied we found that WHtR was the best predictor for high risk of OSA, with AUC of 0.760, 95% CI: 0.699 to 0.815. Conclusions. WHtR was the best predictor for high risk of OSA as assessed by the Berlin Questionnaire.

scholarly journals Effect of Maternal Obstructive Sleep Apnea-Hypopnea on 24-Hour Blood Pressure, Nocturnal Blood Pressure Dipping and Arterial Stiffness in Hypertensive Disorders of Pregnancy

2021 ◽  
Vol 12 ◽  
Author(s):  
Pattaraporn Panyarath ◽  
Noa Goldscher ◽  
Sushmita Pamidi ◽  
Stella S. Daskalopoulou ◽  
Robert Gagnon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Stiffness ◽  
Hypertensive Disorders Of Pregnancy ◽  
Adjusted Analysis ◽  
Nocturnal Blood Pressure ◽  
Hypertensive Disorders ◽  
Obstructive Sleep ◽  
The Impact

Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness.Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses.Results: We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m2) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks’ gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = −0.11, p = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = −0.16, p = 0.01) and MAP (β = −0.13, p = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO2 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, p = 0.04) in unadjusted but not adjusted analysis.Conclusion: Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.

scholarly journals Obstructive Sleep Apnea as a Risk Factor for Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Jacqueline H. Geer ◽  
Guido J. Falcone ◽  
Kevin N. Vanent ◽  
Audrey C. Leasure ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Logistic Regression ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Intracerebral Hemorrhage ◽  
Odds Ratio ◽  
Berlin Questionnaire ◽  
Multivariable Logistic Regression Model ◽  
Obstructive Sleep ◽  
Increased Risk

Background and Purpose: To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls. Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid OSA. We performed logistic regression analyses to evaluate the association between OSA and ICH. Results: Two thousand and sixty-four (71%) cases and 1516 (52%) controls were classified as having OSA by the Berlin Questionnaire. Cases with OSA were significantly more likely to be male and have hypertension, heart disease, hyperlipidemia, and higher body mass index compared with those without OSA. OSA was more common among cases compared with controls (71% versus 52%, odds ratio, 2.28 [95% CI, 2.05–2.55]). In a multivariable logistic regression model, OSA was associated with increased risk for ICH (odds ratio, 1.47 [95% CI, 1.29–1.67]). Conclusions: OSA is a risk factor for ICH.

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