Longitudinal Assessment of Sleep Apnea in the Year After Stroke in a Population-Based Study

Lynda D Lisabeth; Guanghao Zhang; Ronald D Chervin; Xu Shi; Lewis B Morgenstern; Morgan Campbell; Susan Tower; Devin L Brown

doi:10.1161/STROKEAHA.123.042325

Longitudinal Assessment of Sleep Apnea in the Year After Stroke in a Population-Based Study

Stroke. 2023 Sep;54(9):2356-2365. doi: 10.1161/STROKEAHA.123.042325. Epub 2023 Jul 24.

Authors

Lynda D Lisabeth^{1

2}, Guanghao Zhang³, Ronald D Chervin⁴, Xu Shi³, Lewis B Morgenstern^{1

2}, Morgan Campbell⁵, Susan Tower⁵, Devin L Brown²

Affiliations

¹ Department of Epidemiology (L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor.
² Stroke Program (L.D.L., L.B.M., D.L.B.), University of Michigan Health System.
³ Department of Biostatistics (G.Z., X.S.), University of Michigan School of Public Health, Ann Arbor.
⁴ Michael S Aldrich Sleep Disorders Laboratory (R.D.C.), University of Michigan Health System.
⁵ Local Corpus Christi physician (M.C., S.T.).

PMID: 37485665
PMCID: PMC10527822 (available on 2024-09-01)
DOI: 10.1161/STROKEAHA.123.042325

Abstract

Background: The aim of this study was to characterize change in sleep-disordered breathing severity in the year following stroke, overall, and by ethnicity, within the population-based Brain Attack Surveillance in Corpus Christi Project.

Methods: First-ever ischemic strokes (n=414) were ascertained by active and passive surveillance and validated by stroke-trained physicians. Patients with stroke were invited to participate in portable sleep apnea testing (ApneaLink Plus) at baseline and 3, 6, and 12 months poststroke. Sleep-disordered breathing severity was assessed by the respiratory event index (apneas and hypopneas/hour of recording). The component obstructive apnea index and central apnea index were also assessed. Time and ethnicity effects on outcomes, as well as ethnic differences in time effects, were analyzed using generalized estimating equations with multivariable adjustment for confounding factors.

Results: Mean age (n=414) was 63.9 years (SD=10.9); 68.4% were Mexican American. Baseline mean respiratory event index, obstructive apnea index, and central apnea index were 21.3 (SD=16.6), 8.6 (SD=11.5), and 1.5 (SD=3.2), respectively. There was no time effect on respiratory event index (P=0.35) but obstructive apnea index increased over time (P<0.01). Averaged over follow-up, respiratory event index and obstructive apnea index were significantly higher in Mexican American than non-Hispanic White persons. No ethnic difference in the time effect was found for either outcome. For central apnea index, there was an ethnicity-time interaction (P=0.01) such that central apnea index increased in non-Hispanic White but did not change in Mexican American persons.

Conclusions: Sleep-disordered breathing severity was significant and stable for most individuals in the year after stroke. These results do not confirm previous reports of diminishing sleep-disordered breathing severity over time after stroke and would support early assessment and treatment where indicated.

Keywords: brain; ethnicity; ischemic stroke; sleep apnea syndromes.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Ethnicity
Humans
Middle Aged
Risk Factors
Sleep Apnea Syndromes* / diagnosis
Sleep Apnea Syndromes* / epidemiology
Sleep Apnea Syndromes* / etiology
Sleep Apnea, Central*
Stroke* / complications
Stroke* / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding