Investigating the relationship between stroke and obstructive sleep apnea

Background and Purpose We aimed to prospectively determine whether the incidence of obstructive sleep apnea in patients with recent stroke was significantly different from that of a sex- and age-matched control group with no major medical problems. Methods We prospectively performed overnight polysomnography in 24 patients with a recent stroke (13 men and 11 women; mean age [+/-SD], 64.6+/-10.4 years) and 27 subjects without stroke (13 men and 14 women; mean age, 61.6+/-8.8 years). Patients with either ischemic or hemorrhagic stroke were entered into this study. Polysomnographic evaluations were performed within approximately 2 to 5 weeks after each patient's stroke. Results Obstructive sleep apnea was found in 10 of 13 men with stroke (77%) and in only 3 of 13 male subjects without stroke (23%) (P=.0169). Seven of 11 women with stroke (64%) had obstructive sleep apnea, while only 2 of 14 female subjects without stroke (14%) had obstructive sleep apnea (P=.0168). For men with stroke, the mean apnea/hypopnea index (+/-SE) was 21.5+/-4.2 events per hour, while for male subjects without stroke it was 4.8+/-1.8 events per hour (P=.0014). For women with stroke the mean apnea/hypopnea index was 31.6+/-8.8 events per hour, while for female subjects without stroke it was 2.9+/-1.6 events per hour (P=.0024). The 4-year mortality for patients with stroke was 20.8%. All patients with stroke who died had obstructive sleep apnea. Conclusions Patients with stroke have an increased incidence of obstructive sleep apnea compared with normal sex- and age-matched control subjects. Hypoxia and hemodynamic responses to obstructive sleep apnea may have predisposed these patients to stroke.