Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

Carolyn Breauna Sanders; Krista Knisely; Camron Edrissi; Chase Rathfoot; Nicolas Poupore; Leah Wormack; Thomas Nathaniel

doi:10.4103/bc.bc_57_20

Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

Brain Circ. 2021 May 29;7(2):92-103. doi: 10.4103/bc.bc_57_20. eCollection 2021 Apr-Jun.

Authors

Carolyn Breauna Sanders¹, Krista Knisely¹, Camron Edrissi¹, Chase Rathfoot¹, Nicolas Poupore¹, Leah Wormack¹, Thomas Nathaniel¹

Affiliation

¹ Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA.

Abstract

Background: Specific clinical and demographic risk factors may be associated with improving or worsening neurologic outcomes within a population of acute ischemic stroke (AIS) patients with a history of obstructive sleep apnea (OSA). The objective of this study was to determine the changes in neurologic outcome during a 14-day recovery as it relates to initial stroke severity in AIS patients with OSA.

Methods: This retrospective study analyzed baseline clinical risk factors and demographic data collected in a regional stroke center from January 2010 to June 2016. Our primary endpoint measure was the National Institutes of Health Stroke Scale (NIHSS) score and our secondary endpoint measures included the clinical factors associated with improving (NIHSS score ≤7) or worsening (NIHSS score >7) neurological outcome. The relative contribution of each variable to stroke severity and related outcome was determined using a logistic regression. The regression models were checked for the overall correct classification percentage using a Hosmer-Lemeshow test, and the sensitivity of our models was determined by the area under the receiver operating characteristic curve.

Results: A total of 5469 AIS patients were identified. Of this, 96.89% did not present with OSA while 3.11% of AIS patients presented with OSA. Adjusted multivariate analysis demonstrated that in the AIS population with OSA, atrial fibrillation (AF) (odds ratio [OR] = 3.36, 95% confidence interval [CI], 1.289-8.762, P = 0.013) and changes in ambulatory status (OR = 2.813, 95% CI, 1.123-7.041, P = 0.027) showed an association with NIHSS score >7 while being Caucasian (OR = 0.214, 95% CI, 0.06-0.767, P = 0.018) was associated with NIHSS score ≤7.

Conclusion: In AIS patients with OSA, AF and changes in ambulatory status were associated with worsening neurological outcome while Caucasian patients were associated with improving neurological outcome. Our findings may have significant implications for patient stratification when determining treatment protocols with respect to neurologic outcomes in AIS patients with OSA.

Keywords: Acute ischemic stroke; National Institutes of Health Stroke Scale score; obstructive sleep apnea; stroke severity.