Abstract
Introduction: Obstructive sleep apnea (OSA) is a known ischemic stroke risk factor. We analyzed OSA prevalence trends in hospitalized acute ischemic stroke (AIS) patients and treatment utilization and outcomes among AIS patients with and without OSA. Methods: Hospitalized adults 18 and over with a primary diagnosis of AIS per ICD-9 and 10 codes recorded in the Nationwide Inpatient Sample from 2005-2017 were identified. The diagnosis of OSA was identified by ICD-9 and 10 codes. National estimates were generated using discharge weights. Temporal trends in OSA prevalence were analyzed by logistic regression. Links between OSA and IV-tPA and endovascular thrombectomy (EVT) use, mechanical ventilation, discharge disposition, and in-hospital mortality were assessed by adjusted logistic regression models. Results: Of 5,864,798 AIS patients, 234,339 (4.0%) had OSA (intravenous tPA (n=18,421; 7.9%), EVT (n=3,787; 1.6%), in-hospital deaths (n=10,422; 4.5%)). OSA rates in AIS increased from 0.16% in 2005 to 6.3% in 2017 (p-value < .001). OSA AIS patients were younger (mean age 66 vs. 73 years, p<0.01), male (62.4% vs. 46.8%, p-value; p<0.01), White (73.6% vs. 69.1%, p-value p<0.01), obese (67.1% vs. 32.9%, p-value < 0.01), and had a higher Charlson comorbidity index (mean 3.2 vs. 2.6, p-value < 0.01). Adjusting for demographics and comorbidities, OSA AIS versus non-OSA AIS patients were more likely to be treated with IV- tPA and as likely to receive EVT and mechanical ventilation. Adjusting for demographics, comorbidities, and treatments, OSA AIS patients were less likely to die during hospitalization and more likely to be discharged home. Conclusion: Prevalence of OSA among hospitalized AIS patients increased from 2005-2017. OSA AIS patients were treated at a higher rate with IV-tPA and at a similar rate with EVT. OSA AIS patients had better functional outcomes. Further study is needed to understand the mediators of favorable outcomes in AIS patients diagnosed with OSA.
Published Version
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