Sleep apnea in patients hospitalized with acute ischemic stroke: Underrecognition and associated clinical outcomes

Nura Festic, David Alejos, Vikas Bansal, Lesia Mooney, Paul A. Fredrickson, Pablo R. Castillo, Emir Festic

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Study Objectives: To evaluate clinical recognition of sleep apnea and related outcomes in patients hospitalized with acute ischemic stroke. Methods: A retrospective study of all patients hospitalized with acute ischemic stroke from April 2008 to December 2014. The primary predictor and outcome variables were sleep apnea and hospital mortality, respectively. Secondary outcomes were mechanical ventilation, hospital length of stay, and the survivor's functional level by the modified Rankin scale. A sensitivity multivariate regression analysis included the propensity score for cardiovascular comorbidities and sleep apnea. Results: Of 989 patients, 190 (19%) were considered to have sleep apnea. Only 42 patients (22%) received any treatment for sleep apnea during the hospital stay. Despite higher prevalence of cardiovascular comorbidities, the patients with sleep apnea had lower hospital mortality, 1% versus 5.6% in patients without sleep apnea (odds ratio [OR] 0.18; 95% confidence interval [CI], 0.03-0.58, P = .002). Only the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow coma scale (GCS) were significant predictors of adjusted hospital mortality (OR 1.06, 95% CI 1.01-1.11, P = .01 and OR 0.61, 95% CI 0.51-0.69, P ≤ .001, respectively). A composite clinical propensity score for sleep apnea and cardiovascular comorbidities was significantly associated with decreased mortality, independent to either NIHSS (OR 0.11, 95% CI 0.017-0.71; P = .02) or GCS (OR 0.07, 95% CI 0.01-0.52; P = .01). Conclusions: Prevalence of sleep apnea in our study was low, likely because of clinical underrecognition. Despite having more cardiovascular disease, the patients with acute stroke and sleep apnea had less severe neurological injury and lower unadjusted mortality than those without a history of sleep apnea.

Original languageEnglish (US)
Pages (from-to)75-80
Number of pages6
JournalJournal of Clinical Sleep Medicine
Volume14
Issue number1
DOIs
StatePublished - Jan 15 2018

Fingerprint

Sleep Apnea Syndromes
Stroke
Odds Ratio
Confidence Intervals
Hospital Mortality
Comorbidity
Length of Stay
Propensity Score
Glasgow Coma Scale
National Institutes of Health (U.S.)
Mortality
Artificial Respiration
Survivors
Cardiovascular Diseases
Multivariate Analysis
Retrospective Studies
Regression Analysis

Keywords

  • Acute ischemic stroke
  • Ischemic preconditioning
  • Mortality
  • Obstructive sleep apnea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

Sleep apnea in patients hospitalized with acute ischemic stroke : Underrecognition and associated clinical outcomes. / Festic, Nura; Alejos, David; Bansal, Vikas; Mooney, Lesia; Fredrickson, Paul A.; Castillo, Pablo R.; Festic, Emir.

In: Journal of Clinical Sleep Medicine, Vol. 14, No. 1, 15.01.2018, p. 75-80.

Research output: Contribution to journalArticle

Festic, Nura ; Alejos, David ; Bansal, Vikas ; Mooney, Lesia ; Fredrickson, Paul A. ; Castillo, Pablo R. ; Festic, Emir. / Sleep apnea in patients hospitalized with acute ischemic stroke : Underrecognition and associated clinical outcomes. In: Journal of Clinical Sleep Medicine. 2018 ; Vol. 14, No. 1. pp. 75-80.
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abstract = "Study Objectives: To evaluate clinical recognition of sleep apnea and related outcomes in patients hospitalized with acute ischemic stroke. Methods: A retrospective study of all patients hospitalized with acute ischemic stroke from April 2008 to December 2014. The primary predictor and outcome variables were sleep apnea and hospital mortality, respectively. Secondary outcomes were mechanical ventilation, hospital length of stay, and the survivor's functional level by the modified Rankin scale. A sensitivity multivariate regression analysis included the propensity score for cardiovascular comorbidities and sleep apnea. Results: Of 989 patients, 190 (19{\%}) were considered to have sleep apnea. Only 42 patients (22{\%}) received any treatment for sleep apnea during the hospital stay. Despite higher prevalence of cardiovascular comorbidities, the patients with sleep apnea had lower hospital mortality, 1{\%} versus 5.6{\%} in patients without sleep apnea (odds ratio [OR] 0.18; 95{\%} confidence interval [CI], 0.03-0.58, P = .002). Only the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow coma scale (GCS) were significant predictors of adjusted hospital mortality (OR 1.06, 95{\%} CI 1.01-1.11, P = .01 and OR 0.61, 95{\%} CI 0.51-0.69, P ≤ .001, respectively). A composite clinical propensity score for sleep apnea and cardiovascular comorbidities was significantly associated with decreased mortality, independent to either NIHSS (OR 0.11, 95{\%} CI 0.017-0.71; P = .02) or GCS (OR 0.07, 95{\%} CI 0.01-0.52; P = .01). Conclusions: Prevalence of sleep apnea in our study was low, likely because of clinical underrecognition. Despite having more cardiovascular disease, the patients with acute stroke and sleep apnea had less severe neurological injury and lower unadjusted mortality than those without a history of sleep apnea.",
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T2 - Underrecognition and associated clinical outcomes

AU - Festic, Nura

AU - Alejos, David

AU - Bansal, Vikas

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AU - Fredrickson, Paul A.

AU - Castillo, Pablo R.

AU - Festic, Emir

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AB - Study Objectives: To evaluate clinical recognition of sleep apnea and related outcomes in patients hospitalized with acute ischemic stroke. Methods: A retrospective study of all patients hospitalized with acute ischemic stroke from April 2008 to December 2014. The primary predictor and outcome variables were sleep apnea and hospital mortality, respectively. Secondary outcomes were mechanical ventilation, hospital length of stay, and the survivor's functional level by the modified Rankin scale. A sensitivity multivariate regression analysis included the propensity score for cardiovascular comorbidities and sleep apnea. Results: Of 989 patients, 190 (19%) were considered to have sleep apnea. Only 42 patients (22%) received any treatment for sleep apnea during the hospital stay. Despite higher prevalence of cardiovascular comorbidities, the patients with sleep apnea had lower hospital mortality, 1% versus 5.6% in patients without sleep apnea (odds ratio [OR] 0.18; 95% confidence interval [CI], 0.03-0.58, P = .002). Only the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow coma scale (GCS) were significant predictors of adjusted hospital mortality (OR 1.06, 95% CI 1.01-1.11, P = .01 and OR 0.61, 95% CI 0.51-0.69, P ≤ .001, respectively). A composite clinical propensity score for sleep apnea and cardiovascular comorbidities was significantly associated with decreased mortality, independent to either NIHSS (OR 0.11, 95% CI 0.017-0.71; P = .02) or GCS (OR 0.07, 95% CI 0.01-0.52; P = .01). Conclusions: Prevalence of sleep apnea in our study was low, likely because of clinical underrecognition. Despite having more cardiovascular disease, the patients with acute stroke and sleep apnea had less severe neurological injury and lower unadjusted mortality than those without a history of sleep apnea.

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KW - Ischemic preconditioning

KW - Mortality

KW - Obstructive sleep apnea

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