Abstract TP215: Clinical Phenotypes of Obstructive Sleep Apnea in Stroke Patients: A Cluster Analysis

Abstract

Introduction: Obstructive sleep apnea (OSA) is highly prevalent in stroke survivors. Untreated OSA is associated with an increased risk of adverse cardiovascular outcomes and OSA treatment may improve neurological recovery in stroke survivors, yet OSA in stroke patients remains poorly characterized. To our knowledge, this is the first study aiming to identify OSA phenotypes in stroke survivors. Methods: Patients (n=451) with ischemic strokes and OSA (apnea-hypopnea index (AHI) ≥ 10 using a cardiopulmonary screening device (ApneaLink Plus)) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Latent class analysis was performed based on the following variables: age, sex, race/ethnicity, AHI, pre-stroke snoring, pre-stroke tiredness/fatigue, pre-stroke sleep duration, prior stroke history, initial NIHSS, BMI, hypertension, diabetes, atrial fibrillation, coronary artery disease, and congestive heart failure. Results: A model with 3 phenotype clusters provided the best fit. Cluster 1 (n=55, 12%) was defined by higher NIHSS scores and high prevalence of snoring. Patients in cluster 2 (n=253, 56%) were younger and had relatively low NIHSS scores. Cluster 3 (n=143, 32%) included patients with severe OSA and higher prevalence of medical comorbidities. Conclusion: Ischemic stroke survivors with OSA can be categorized into three clinical phenotype clusters characterized by differences in stroke severity, OSA severity, patient age and medical comorbidities. This highlights the heterogeneity of post-stroke OSA. Awareness of the different faces of OSA in patients with ischemic stroke may help clinicians identify OSA in their patients, and informs research concerning the pathophysiology and prognostication of post-stroke OSA.