Effects of severe obstructive sleep apnea on functional prognosis in the acute phase of ischemic stroke and quantitative electroencephalographic markers

Juan Xu; Jianhua Wang; Huaman Wu; Fei Han; Qiaojun Wang; Yongqian Jiang; Rui Chen

doi:10.1016/j.sleep.2022.11.035

Effects of severe obstructive sleep apnea on functional prognosis in the acute phase of ischemic stroke and quantitative electroencephalographic markers

Sleep Med. 2023 Jan:101:452-460. doi: 10.1016/j.sleep.2022.11.035. Epub 2022 Dec 5.

Authors

Juan Xu¹, Jianhua Wang², Huaman Wu³, Fei Han³, Qiaojun Wang³, Yongqian Jiang⁴, Rui Chen⁵

Affiliations

¹ Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng City, Yancheng, China.
² Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, Zigong Third People's Hospital, Zigong, China.
³ Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China.
⁴ Department of Respiratory Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng City, Yancheng, China. Electronic address: ycjiangyq@126.com.
⁵ Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China. Electronic address: chenruigood@126.com.

PMID: 36516602
DOI: 10.1016/j.sleep.2022.11.035

Abstract

Objective: To investigate the effect of severe obstructive sleep apnea (OSA) on functional prognosis in the acute phase and quantitative electroencephalography (EEG) markers during sleep in ischemic stroke patients.

Methods: This study included 125 mild-to-moderate acute ischemic stroke patients with OSA who underwent polysomnography (PSG) within one week of stroke onset between January 2015 and June 2020. Patients were grouped according to their apnea-hypopnea index (</≥ 30/h). Poor functional prognosis was defined as modified Rankin Scale score ≥3. The EEG recorded by PSG was extracted during different sleep stages for power spectrum analysis. The delta/alpha power ratio (DAR), (delta + theta)/(alpha + beta) ratio (the slowing ratio, TSR), and the relative power (RP) of each frequency band were calculated. Differences in clinical, PSG, and quantitative EEG characteristics were compared between the groups. Additionally, we explored predictors of poor functional prognosis.

Results: Patients with severe OSA had a higher proportion of hypertension, lower relative power of high-frequency bands, and higher delta RP, TSR, and DAR (p < 0.05). Severe OSA was associated with a 3.6-fold increase in risk of poor prognosis (p < 0.05). Increased delta RP and TSR, as well as decreased alpha, beta, and sigma RP, may be independent predictors of a poor functional prognosis.

Conclusions: Severe OSA is an independent risk factor for a poor functional prognosis in patients with acute ischemic stroke, and quantitative EEG during sleep showed a significant slow wave enhancement, suggesting more severe brain dysfunction. The treatment of severe OSA may improve functional prognosis.

Keywords: Acute ischemic stroke; Obstructive sleep apnea; Prognosis; Quantitative electroencephalogram; The slowing ratio.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Electroencephalography*
Humans
Ischemic Stroke* / complications
Ischemic Stroke* / diagnosis
Prognosis
Sleep
Sleep Apnea, Obstructive* / complications