Frequent co-existence of atrial fibrillation and obstructive sleep apnoea in stroke patients

Obstructive sleep apnoea (OSA) is a well-established risk factor for both ischaemic stroke and atrial fibrillation. In a retrospective Italian study, half of the patients with acute ischaemic stroke also suffered from OSA. These findings support a possible link between apnoea-related hypoxia and ischaemic stroke.

The suggested mechanisms linking OSA with ischaemic stroke include haemodynamic, neural, circadian, vascular, metabolic, inflammatory, and thrombotic processes.

Dr Maria Rita Lo Monaco (Catholic University of the Sacred Heart, Italy) and her team conducted a study that aimed to evaluate the prevalence of atrial fibrillation and obstructive sleep apnoea in participants with acute ischaemic stroke within 7 days of onset [1].

The researchers collected data retrospectively from 146 participants over 4 years, encompassing clinical, neurological, and cardiological evaluations. Various patient parameters were analysed, including age, sex, BMI, wake-up stroke, National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), Groningen Upper Extremity Motor Score (GUSS), Apnea-Hypopnea Index (AHI), oxygen desaturation index (ODI), OSA severity, atrial fibrillation, and other cardiac risk factors.

In the participants with ischaemic stroke, OSA prevalence was as high as 50%. The study further revealed that out of the 146 enrolled participants, 41 (28%) had documented episodes of atrial fibrillation. Notably, 22 participants (15%) were affected by both atrial fibrillation and OSA. This observed association was higher (15%) than expected when only considering each pathology separately (10%).

These results support the potential pathogenesis of apnoea-related hypoxia, which poses a significant risk of ischaemic stroke, especially in patients with atrial fibrillation. The findings underscore the importance of considering the co-existence of atrial fibrillation and OSA in stroke patients, as their association may indicate a pathogenic mechanism and influence treatment strategies to prevent future strokes.

1. Lo Monaco MR, et al. Impact of sleep apnea and atrial fibrillation in patients with ischemic stroke. Session E-Posters in preventive cardiology, Heart Failure 2023, 20–23 May, Prague, Czechia.

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Posted on 8 August, 202320 February, 2024