Abstract P597: Growing Prevalence of Post-Stroke Sleep-Disordered Breathing

Introduction: Sleep-disordered breathing (SDB) is common after stroke and is associated with poor functional and cognitive outcomes, and recurrent stroke. Despite increasing prevalence of SDB in the general population, no data are available about trends in post-stroke SDB. We therefore sought to assess changes in post-stroke SDB prevalence over a 10-year period. Methods: Within the Brain Attack Surveillance In Corpus Christi (BASIC) project, a population-based stroke surveillance study in south Texas, participants with acute ischemic stroke were offered assessment of SDB with the ApneaLink Plus device. Medical record abstraction and baseline interviews were conducted and included the Berlin questionnaire to assess SDB status in reference to the prestroke state. SDB testing was performed shortly after stroke presentation (median 12 days (IQR: (6, 21)). Respiratory event index (REI) was calculated as the sum of apneas and hypopneas per hour of overnight recording. SDB was defined as an REI ≥10. SDB assessment procedures remained unchanged throughout (2010-2020). Logistic (SDB) and linear (REI) regression were used to test associations with time (parameterized as years since 2010) adjusted for demographics, and stroke and SDB risk factors including BMI and pre-stroke SDB status. Results: Among the 1,197 participants, median age was 65, 53% were male, and 65% were Mexican American. SDB prevalence was 61% in 2010-2011 and 75% in 2018-2019. Median REI was 19 in 2010-2011 and 23 in 2018-2019. A linear association was identified between time and SDB (REI≥10), with an odds ratio of 1.123 (95% CI: 1.062, 1.187) per year, after adjustment. Similarly, a linear association was identified between time and REI, with an average increase of 0.504 (95% CI: 0.148, 0.860) per year, after adjustment. Based on models with interaction terms added, no differences in time trends were found by sex or ethnicity. Conclusions: Post-stroke SDB prevalence in this population-based sample has increased over the last 10 years. These data highlight the importance of post-stroke SDB and the pressing need to determine whether its treatment improves outcomes.

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Abstract WP357: Prevalence of Pre- and Post-intracerebral Hemorrhage Sleep-disordered Breathing

Stroke ◽

10.1161/str.48.suppl_1.wp357 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Richard V Scheer ◽

Lynda D Lisabeth ◽

Chengwei Li ◽

Erin Case ◽

Ronald D Chervin ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Mexican American ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Portable Monitor ◽

Before And After ◽

Disordered Breathing

Background: Sleep-disordered breathing (SDB) is an independent risk factor for stroke. The reported prevalence of SDB after stroke ranges from 60 to >70%, while the pre-stroke prevalence of SDB is less well described. Moreover, much of these data are derived from ischemic stroke or mixed ischemic stroke and intracerebral hemorrhage (ICH) cohorts. Studies that assess the prevalence of SDB before and after ICH are lacking, with only one prior study (n=32) that reported a post-ICH SDB prevalence of 78%. We report herein the results of a second, larger, prospective study that assessed the prevalence of pre- and post-ICH. Methods: Participants enrolled in the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) project, with ICH from 2010-2015 were screened for SDB with the well validated ApneaLink Plus portable monitor (SDB defined as apnea-hypopnea index (AHI) ≥10). The Berlin questionnaire was administered, with reference to the pre-ICH state, to assess for possible pre-stroke SDB. Results: Of the 60 ICH participants screened, the median age was 63 years (interquartile range (IQR): 55.5, 74.5). Twenty-one (35%) were female, 54 (90%) were Mexican American, and 53 (88%) had a history of hypertension. The median Glasgow Coma Scale score was 15.0 (IQR: 15.0, 15.0) and the median NIHSS was 5.5 (IQR: 1.5, 8.0). Post-ICH, the median AHI was 9.5 (IQR: 5.5, 19.0); almost half (46.7%) met criteria for SDB. Thirty-four participants (56.7%) screened as high risk for SDB pre-ICH. Conclusion: Sleep-disordered breathing was highly prevalent after ICH, and also likely common before ICH, in this mostly Mexican American, community-based sample. If SDB increases risk for ICH, the findings suggest a potential new treatment target to prevent ICH and recurrent ICH.

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Wake-up stroke is not associated with sleep-disordered breathing in women

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000412 ◽

2018 ◽

Vol 8 (1) ◽

pp. 8-14 ◽

Cited By ~ 4

Author(s):

Devin L. Brown ◽

Chengwei Li ◽

Ronald D. Chervin ◽

Erin Case ◽

Nelda M. Garcia ◽

...

Keyword(s):

Symptom Onset ◽

Mexican American ◽

Sleep Disordered Breathing ◽

Onset Time ◽

Population Based ◽

Nocturnal Sleep ◽

Population Based Study ◽

Stroke Symptom ◽

Respiratory Event ◽

Disordered Breathing

BackgroundWe sought to investigate the frequency of wake-up stroke (WUS) and its association with sleep-disordered breathing (SDB) in women.MethodsWithin a population-based study, women with acute ischemic stroke were asked about their stroke symptom onset time. SDB screening was performed with the well-validated ApneaLink Plus device; SDB was defined by a respiratory event index ≥10. Logistic regression was used to test the association between SDB presence and severity and WUS unadjusted and adjusted for potential confounders including prestroke depression and sleep duration.ResultsAmong 466 participants, the median age was 67.0 years (interquartile range [IQR] 58.0, 77.0), 55% were Mexican American, and the median initial NIH Stroke Scale score was 3.0 (IQR 1.0, 6.0). Stroke symptom onset occurred during nocturnal sleep (25.3%), during a nap (3.9%), during wakefulness (65.9%), or unknown (4.9%). In those with SDB screening performed (n = 259), a median of 11 days (IQR 5, 17) poststroke, WUS was not associated with the presence or severity (respiratory event index) of SDB in unadjusted or adjusted analysis.ConclusionsIn this population-based study, WUS represented about 30% of all generally mild severity ischemic strokes in women and was not associated with SDB.

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Sleep disordered breathing: prevalence and association with cardiovascular disease in the French general population

European Heart Journal ◽

10.1093/ehjci/ehaa946.2884 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Balagny ◽

E Wiernik ◽

J Matta ◽

J Frija-Masson ◽

E Vidal-Petiot ◽

...

Keyword(s):

Cardiovascular Disease ◽

Public Hospital ◽

Sleep Disordered Breathing ◽

Population Based ◽

Berlin Questionnaire ◽

Funding Source ◽

French Population ◽

Limited Sample ◽

Disordered Breathing

Abstract Background Sleep Disordered Breathing (SDB) is highly prevalent and associated with cardiovascular disease (CVD) but many studies have a limited sample size or uncertain generalizability. Purpose The aim of this study was to obtain contemporary data on SDB prevalence and to assess its impact on CVD occurrence in a large French population-based sample. Methods Data came from participants of the French population-based CONSTANCES cohort, included between 2012 and 2016, with clinical interview, examination and standard biology at inclusion and who were screened for SDB in 2017 using the Berlin Questionnaire (BQ). Follow-up was performed through yearly CONSTANCES questionnaires. CVD occurrence was defined by self-declared myocardial infarction or stroke between 2013 and 2017. Exposure variables were SDB diagnosis on the basis on BQ and its related sleeping symptoms (snoring, apnea and sleepiness). Odds Ratios (OR) were computed with their 95% Confidence Interval (95% CI) and adjusted for age, sex, smoking, dyslipidemia, diabetes, hypertension and body mass index (except for SDB since BQ considers these variables). Results Among 54 228 participants, SDB prevalence was 16.1%. Over four years of follow-up, CVD occurred in 2.23% of SDB participants vs 0.72% in non SDB (OR=1.72, 95% CI [1.41–2.09]). CVD occurrence did not increase significantly with snoring (OR=0.95, 95% CI [0.78; 1.17]), but with apnea (OR=1.34, 95% CI [1.05; 1.71]) and with sleepiness (OR=1.42, 95% CI [1.18–1.72] when fatigue occurred after-sleep and OR=1.62, 95% CI [1.33–1.97] during waking time). These associations remained non-significant for snoring regardless of its frequency or noise, were significant for sleepiness as soon as it happened at least once a week and tended to increase with its frequency whenever fatigue occurred (p for trend<0.001). Subgroups analysis in hypertensive and non-hypertensive participants found similar results concerning snoring and sleepiness. Conclusions These results confirm that SDB is highly prevalent in the general French population and is associated with a higher occurrence of CVD particularly in sleepy and apneic subjects. Screen for SDB and its symptoms should be relevant to identify high cardiovascular risk people who would benefit from preventive measures. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Plan d'Investissement d'Avenir-3 (PIA3-RHU, Ministry of Health)

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Abstract TMP79: Pre-Stroke Sleep Apnea and Post-Stroke Depression

Stroke ◽

10.1161/str.51.suppl_1.tmp79 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Liming Dong ◽

Devin Brown ◽

Ronald Chervin ◽

Erin Case ◽

Lewis Morgenstern ◽

...

Keyword(s):

Risk Factor ◽

Sleep Apnea ◽

High Risk ◽

Mexican American ◽

Independent Risk Factor ◽

Population Based ◽

Berlin Questionnaire ◽

Post Stroke ◽

Post Stroke Depression ◽

Positive Score

Introduction: Sleep apnea is an independent risk factor for stroke and strongly associated with depression; however, little is known about its role in predicting depression after stroke among stroke survivors. This study examined the association between pre-stroke sleep apnea risk and depression at 90 days post-stroke in a population-based sample. Methods: Data were obtained from the Brain Attack Surveillance in Corpus Christi (BASIC) project, a population-based stroke study in south Texas. The study sample consisted of 1,383 participants who had ischemic or hemorrhagic stroke between August 2010 and December 2016. Depression after stroke was measured by the 8-item Patient Health Questionnaire (range: 0-24). Participants scoring 10 or above were classified as having depression. Pre-stroke sleep apnea risk assessed at stroke onset was classified as high or low based on Berlin Questionnaire scores (high risk: 2 or more categories with a positive score; low risk: 0-1 category with a positive score). Inverse probability weighting and multiple imputation were used to deal with attrition and missing covariate data. Weighted logistic regression models were used to examine the association between pre-stroke sleep apnea risk and post-stroke depression. Results: Mean age of participants was 68.1 years (SD=12.3), men and women were evenly distributed, 59.4% were Mexican American, and 59.2% were at high risk for sleep apnea before stroke. High-risk participants were significantly more likely to be men, Mexican American, obese and on medication for depression at the time of stroke. Pre-stroke sleep apnea risk was associated with post-stroke depression (Odds Ratio [OR]=1.78, 95% Confidence Interval [CI]=1.38-2.29), even after adjustment for sociodemographic characteristics, smoking, obesity, pre-stroke depression status and stroke severity (OR=1.60, 95% CI=1.19-2.14). Conclusions: Pre-stroke sleep apnea may be an independent risk factor for post-stroke depression. Treatment of sleep apnea before or perhaps even after stroke may reduce risk for depression after stroke.

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Abstract P105: Sleep Disordered Breathing and Cardiac Autonomic Modulation in Adolescents - Penn State Child Cohort (PSCC) Study

Circulation ◽

10.1161/circ.129.suppl_1.p105 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Edward O Bixler ◽

Fan He ◽

Sol Rodriguez-Colon ◽

Julio Fernandez-Mendoza ◽

Alexandros Vgontzas ◽

...

Keyword(s):

Heart Rate ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Autonomic Modulation ◽

Rr Intervals ◽

Cardiac Autonomic Modulation ◽

The Mean ◽

Frequency Power ◽

Disordered Breathing

Objectives: To investigate the relationship between sleep disordered breathing (SDB) and cardiac autonomic modulation (CAM) in a population-based sample of adolescents. Methods: We used available data from 400 adolescents who completed the follow up examinations in the population-based PSCC study. 1-night polysomnography was used to assess apnea hypopnea index (AHI). AHI was used to define no-SDB (AHI<1), mild SDB (1≤AHI<5), and moderate SDB (AHI≥5). CAM was assessed by heart rate variability (HRV) analysis of beat-to-beat normal R-R intervals from a 39-hour high resolution Holter ECG. The HRV indices in frequency domain [high frequency power (HF), low frequency power (LF), and LF/HF ratio] and time domain [standard deviation of normal RR intervals (SDNN), and the square root of the mean squared difference of successive normal RR intervals (RMSSD), and heart rate (HR)] were calculated on a 30-minute basis (78 repeated measures). Mixed-effects models were used to assess the SDB and HRV relationship. Results: The mean age was 16.9 yrs (SD=2.19), with 54% male and 77% white. The mean (SD) AHI were 0.52 (0.26), 2.38 (1.03), and 12.27 (14.54) for no-, mild-, and moderate-SDB participants. The age, race, sex, and BMI percentile adjusted mean (SE) HRV indices across three SDB groups are presented in Table 1. In summary, sleep disordered breathing was associated with lower HRV and higher HR in this population-based adolescent sample, with a significant dose-response relationship. Conclusion: moderate SDB in adolescents is already associated with lower HRV, indicative of sympathetic activation and lower parasympathetic modulation, which has been associated with cardiac events in adults.

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Abstract P249: Incident Sleep-Disordered Breathing is Associated with Obesity: Penn State Child Cohort

Circulation ◽

10.1161/circ.127.suppl_12.ap249 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Edward O Bixler ◽

Alexandros N Vgontzas ◽

Duanping Liao ◽

Susan Calhoun ◽

Julio Fernandez-Mendoza ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Sleep Disordered Breathing ◽

Population Sample ◽

Population Based ◽

Penn State ◽

Potential Risk Factors ◽

State Child ◽

Disordered Breathing

Objectives: To study the epidemiology of sleep-disordered breathing (SDB) in adolescents, which has received little attention. Methods: The Penn State Child Cohort (PSCC) is a representative general population sample of 700 children aged 5-12 years. Our preliminary results are based on an average 8 year follow up of the initial 300 prospective subjects (~43%) from this ongoing cohort study. A logistic regression was used to assess the association between potential risk factors and incident SDB. Results: The mean age at the 8-year follow up examination was 17.2 ± 0.1 years, with an average BMI percentile of 66.6 ± 1.6 and 56.5% boys. At baseline 1.5% of this subsample had SDB, defined by Apnea Hypopnia Index (AHI > 5 /hour). Surprisingly, there was no persistence of SDB. Eight-year incident SDB was 10.5%. The average AHI in those with incident SDB was 12.7 with a maximum of 92.4. Incident SDB was similar for girls (7.8%) and boys (12.7%). Those with SDB were older than those without (18.7 vs 17.0 years, P<0.001) and girls with SDB were older than boys with SDB (20.0 vs 18.0 years, P=0.002). Those with incident SDB tended to have a greater change in BMI percentile (8.2 vs 1.8, P = 0.143) during the follow up and slightly higher minority representation (25.8% vs 21.9%, P=0.655). A logistic regression model identified three variables that were associated with incident SDB, controlling for baseline AHI: age (OR = 1.5 (1.3, 1.9) P<0.001), male (OR= 2.5 (1.11,10.00) P=0.021), and [[Unable to Display Character: ∆]]BMIPCT (OR=1.2(1.02, 1.5) P=0.032). Conclusion: In this population based sample of adolescents, the 8-year incidence of SDB was high (10.5%), whereas childhood SDB did not persist into adolescence. Further, the results indicate that risk factors for incident SDB in adolescents are age, male and the development of obesity.

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Sleep fragmentation and sleep-disordered breathing in individuals living close to main roads: results from a population-based study

Sleep Medicine ◽

10.1016/j.sleep.2013.10.014 ◽

2014 ◽

Vol 15 (3) ◽

pp. 322-328 ◽

Cited By ~ 3

Author(s):

M.W. Gerbase ◽

J. Dratva ◽

M. Germond ◽

J.M. Tschopp ◽

J.L. Pépin ◽

...

Keyword(s):

Sleep Disordered Breathing ◽

Population Based ◽

Sleep Fragmentation ◽

Population Based Study ◽

Disordered Breathing

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0890 Sleep Disordered Breathing is Associated With Endothelial Dysfunction and Atherosclerosis in Young Adults: Preliminary Longitudinal Findings in the Penn State Child Cohort

SLEEP ◽

10.1093/sleep/zsaa056.886 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A339-A339

Author(s):

J Fernandez-Mendoza ◽

Z Gao ◽

K Brandt ◽

L Houser ◽

S L Calhoun ◽

...

Keyword(s):

Young Adults ◽

Endothelial Dysfunction ◽

Young Adulthood ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Penn State ◽

State Child ◽

Disordered Breathing

Abstract Introduction Sleep disordered breathing (SDB) in middle-age is an established risk factor for cardiovascular disease. However, population-based studies supporting its cardiovascular contribution at earlier stages of development are lacking, particularly with long-term follow-ups. Methods The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) with in-lab polysomnography (PSG). To date, 425 have been followed-up another 7.4 years later during young adulthood (24.4±2.6y) via a standardized survey and 136 of them (55.1% female, 21.3% racial/ethnic minority) have undergone a repeat of their PSG to ascertain apnea/hypopnea index. Subjects (n=121) also underwent Doppler ultrasounds to assess flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT). Linear regression models stratified by body mass index in young adulthood. Results SDB was cross-sectionally associated with lower FMD (β=-0.239, p=0.008) and greater CIMT (β=0.330, p<0.001) in young adulthood. Longitudinally, childhood (n=121) and adolescence (n=90) SDB were significantly associated with CIMT (β=0.327, p<0.001 and β=0.286, p=0.006, respectively), but not with FMD (β=-0.158, p=0.08 and β=-0.101, p=0.35, respectively). These associations, particularly longitudinal ones between childhood and adolescence SDB with CIMT in young adulthood, were stronger in overweight than normal weight subjects (e.g., β=0.310, p=0.030 and β =0.089, p=0.582, respectively). Conclusion SDB and obesity appear to be synergistically associated with endothelial dysfunction and atherosclerosis in young adults from the general population. These data suggest that a childhood exposure to chronic SDB is associated with long-term atherosclerosis, while endothelial dysfunction may be a short-term outcome. This ongoing 16-year longitudinal study will test whether the natural history of SDB from childhood through adolescence into young adulthood shows differential trajectories for cardiovascular morbidity. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

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Validation of the NoSAS Score for the Screening of Sleep-Disordered Breathing in a Sleep Clinic

Canadian Respiratory Journal ◽

10.1155/2020/4936423 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Yi Rong ◽

Shihan Wang ◽

Hui Wang ◽

Feng Wang ◽

Jingjing Tang ◽

...

Keyword(s):

Predictive Value ◽

Sleep Disordered Breathing ◽

Screening Tool ◽

Characteristic Curve ◽

Population Based ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Portable Monitor ◽

Number Of Patients ◽

Disordered Breathing

Background. There is a growing number of patients with sleep-disordered breathing (SDB) referred to sleep clinics. Therefore, a simple but useful screening tool is urgent. The NoSAS score, containing only five items, has been developed and validated in population-based studies. Aim. To evaluate the performance of the NoSAS score for the screening of SDB patients from a sleep clinic in China, and to compare the predictive value of the NoSAS score with the STOP-Bang questionnaire. Methods. We enrolled consecutive patients from a sleep clinic who had undergone apnea-hypopnea index (AHI) testing by type III portable monitor device at the hospital and completed the STOP-Bang questionnaire. The NoSAS score was assessed by reviewing medical records. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) of both screening tools were calculated at different AHI cutoffs to compare the performance of SDB screening. Results. Of the 596 eligible patients (397 males and 199 female), 514 were diagnosed with SDB. When predicting overall (AHI ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB, the sensitivity and specificity of the NoSAS score were 71.2, 80.4, and 83.1% and 62.4, 49.3, and 40.7%, respectively. At all AHI cutoffs, the AUC ranged from 0.688 to 0.715 for the NoSAS score and from 0.663 to 0.693 for the STOP-Bang questionnaire. The NoSAS score had the largest AUC (0.715, 95% CI: 0.655–0.775) of diagnosing SDB at AHI cutoff of ≥5 events/h. NoSAS performed better in discriminating moderate-to-severe SDB than STOP-Bang with a marginally significantly higher AUC (0.697 vs. 0.663, P=0.046). Conclusion. The NoSAS score had good performance on the discrimination of SDB patients in sleep clinic and can be utilized as an effective screening tool in clinical practice.

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