Relationship between obstructive sleep apnea-hypopnea syndrome and symptomatic carotid stenosis in patients with ischemic cerebrovascular disease

Abstract

Objective To investigate the relationship between obstructive sleep apneahypopnea syndrome （OSAHS） and carotid stenosis in patients with ischemic cerebrovascular disease （ICVD） and to provide reference for developing the intervention strategy of carotid stenosis. Methods Eighty-seven patients with ICVD were screened from Nanjing Stroke Registry Program. The patients were divided into without （n=21）, mild（n=24）, moderate （n=27） and severe （n = 11） OSAHS groups according to the apnea-hypopnea index （AHI）; in addition, the patients were divided into with （n =34） and without carotid stenosis （n=49） groups according to the results of digital subtraction angiography （DSA）. The effects of the risk factors for cerebrovascular diseases and OSAHS on carotid stenosis in patients with ICDV were analyzed.Results There were significant differences in the proportions of alcohol consumption （χ2=8.56, P =0. 036）, hypertension （χ2 = 13.20, P =0. 004） and carotid stenosis （χ2 =22.97, P =0. 006） between the no OSAHS and the mild, moderate and severe OSAHS groups. The univariate analysis showed that age （OR = 1. 066, 95% CI 1. 023- 1.112; P = 0. 003）,hypertension （OR =3.587, 95% CI 1. 294- 9. 949; P =0. 014）, alcohol consumption （OR =5.275,95% CI 1.855-15.001; P= 0.002） and OSAHS （OR= 1.073, 95% CI 1.033-1.115; P = 0. 000） were the risk factors for carotid stenosis. The multivariate logistic regression analysis showed that age （OR = 1. 113, 95% CI 1. 047-1. 182; P =0. 001）, OSAHS （OR = 1. 096, 95% CI 1. 034-1. 160; P = 0. 000）, and alcohol consumption （OR = 4. 292,95% CI 1. 217-15. 139; P = 0. 024） were the independent risk factors for carotid stenosis.Spearman rank correlation analysis suggested that the AHI levels were positively correlated with the degree of carotid stenosis （r = 0. 435, P = 0. 000）. There were significant differences among the without stenosis （n =34）, unilateral stenosis （n =22）, and bilateral stenosis （n=27）groups （12.97 ± 10.04 vs. 21.40 ± 16.38 vs. 29.33 ± 13.81, F= 11.64, P〈0.01）.Conclusions OSAHS is an independent risk factor for carotid stenosis and it was positively correlated with the severity of carotid stenosis. AHI may reflect the degree of carotid stenosis and the range of neck vascular involvement to some extent. Key words: Carotid stenosis; Sleep apnea, obstructive; Stroke; Ischemic attack, transient; Angiography, digital subtraction