Obstructive sleep apnea: highly prevalent in patients with acute ischaemic stroke

In a retrospective Italian study, half of the patients with acute ischaemic stroke also suffered from obstructive sleep apnea and another 28% from atrial fibrillation. These findings support the potential pathogenetic role of apnea-related hypoxia in ischaemic stroke.

Risk assessment in patients with atrial fibrillation is of key importance to reduce the future risk of stroke. Obstructive sleep apnea (OSA) is a well-established risk factor for both ischaemic stroke and atrial fibrillation [1]. The mechanisms linking OSA with ischaemic stroke involve various factors, including haemodynamic, neural, circadian, vascular, metabolic, inflammatory, and thrombotic processes.

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

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, body mass index (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 had documented episodes of atrial fibrillation. Notably, 22 participants were affected by both atrial fibrillation and obstructive sleep apnea. This observed association was higher (15%) than expected when only considering each pathology separately (10%).

These results support the potential pathogenesis of apnea-related hypoxia, which poses a significant risk of ischaemic stroke in patients with atrial fibrillation. The findings underscore the importance of considering the co-existence of atrial fibrillation and obstructive sleep apnea 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 23 May, 202323 May, 2023