390 Risk of Obstructive Sleep Apnea: A Comparison Between Ischemic and Hemorrhagic Stroke

Abstract

Abstract Introduction Obstructive Sleep Apnea (OSA) is common amongst stroke patients. Distinction between the prevalent types of stroke when evaluating sleep may prove useful to prevent recurrent strokes. There is a lack of information on how apnea prevalence following ischemic stroke compares to hemorrhagic stroke, particularly during the chronic period. Here we set out to retrospectively determine if apnea incidence was more marked in ischemic stroke patients compared to those that received a hemorrhagic stroke diagnose; while taking in account medications taken during the sleep evaluation. Methods Medical records were reviewed from 103 patients diagnosed with stroke that underwent a type I fully attended overnight polysomnography. Diagnosis of embolic, thromboembolic or hemorrhagic stroke was obtained from a neurological report that was typically confirmed by computed tomography or magnetic resonance imaging. Medications that the subject was taking at the time of the sleep study were documented by the sleep technologist. Results Arousals and microarousal index was higher in the ischemic group (p<0.005). Age adjusted assessment of apnea and hypopnea events, indicated that subjects with an ischemic stroke had a higher incidence of apnea and hypopnea compared to the hemorrhagic group (p<0.005). Ischemic subjects were also more likely to present severe apnea (AHI > 30) (p<0.005). In comparison, a higher percentage of hemorrhagic subjects had an AHI below 5 (p<0.005). Type of hemorrhagic stroke did not have an impact on apnea/hypopnea variables. Those with an ischemic stroke were taking significantly more lipid lowering agents (p<0.05). Logistic regression analysis indicated that the predictive probability of apnea (AHI > 5) increased from 0.55 to 0.81 (p < 0.05) when anti-hypertensive use was considered. An increase in predictive values for apnea was observed for indicators of diabetes such as use of anti-diabetics with or without consideration of diabetic history (p < 0.05). Conclusion Data suggests that ischemic patients present a higher artherosclerotic load that may contribute to the higher incidence of severe OSA. These data indicate that it is relevant to consider stroke type when determining the risk of OSA thus facilitating new strategies for stroke recurrence prevention. Support (if any):