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

Abstract

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.