Sex Differences in 90-Day Functional Outcomes for Acute Ischemic Stroke Patients With Obstructive Sleep Apnea

Adriana N Devenish; Tariq Nisar; Amber Criswell; David McCane; Dinh Thao; Ken Chyuan Ling; David Chiu; Rajan Gadhia

doi:10.7759/cureus.39652

Sex Differences in 90-Day Functional Outcomes for Acute Ischemic Stroke Patients With Obstructive Sleep Apnea

Cureus. 2023 May 29;15(5):e39652. doi: 10.7759/cureus.39652. eCollection 2023 May.

Authors

Adriana N Devenish¹, Tariq Nisar², Amber Criswell³, David McCane², Dinh Thao³, Ken Chyuan Ling², David Chiu², Rajan Gadhia³

Affiliations

¹ Neurological Institute, Houston Methodist Hospital, Houston, USA.
² Neurology, Houston Methodist Hospital, Houston, USA.
³ Neurology, Houston Methodist Neurological Institute, Houston, USA.

Abstract

Background Obstructive sleep apnea (OSA) is characterized by repeated episodes of either full or partial obstruction of the upper airway. OSA is an independent risk factor for acute ischemic stroke (AIS) and a contributor to other key risk factors. OSA may damage endothelial and brain tissues and worsen outcomes following AIS. We aimed to evaluate the impact of sex differences on 90-day functional outcomes following AIS in an OSA population, as measured by the modified Rankin Scale (mRS) score. Methodology We performed a retrospective study of patients with OSA and AIS from the Houston Methodist Hospital Outcomes-Based Prospective Endpoints in Stroke (HOPES) Registry from 2016 to 2022. Patients with charts that noted a diagnosis of OSA before AIS or within the 90 days following AIS were included. A multivariable logistic regression model was constructed adjusting for demographics, first admit National Institutes of Health Stroke Scale (NIHSS), and comorbidities on the binary outcome. The odds ratios (ORs) and 95% confidence intervals (CIs) were reported, providing likelihood estimates of a shift to higher mRS for a given comparison between females (reference category) and males. Statistical significance was defined as two-tailed p-values <0.05 for all tests. Results From the HOPES registry, 291 females and 449 males were found to have OSA. Males had a higher proportion of comorbid conditions such as atrial fibrillation (15% vs. 9%, p = 0.014) and intracranial hemorrhage compared to females (6% vs. 2%, p = 0.020). The multivariate logistic regression model showed that males were at two times higher risk for developing poor functional outcomes at 90 days (OR = 2.35, 95% CI = 1.06-5.19), p < 0.001). Conclusions Males were found to have two times higher risk for developing poor functional outcomes at 90 days. This may be due to more severe oxygen desaturation, increased susceptibility to oxidative stress, and greater frequency of full airway obstruction in males. Greater emphasis on early diagnosis and treatment of OSA may be necessary to reduce the disproportionate incidence of poor functional outcomes, particularly among apneic male stroke survivors.

Keywords: ais (acute ischemic stroke); atherosclerosis (as); atrial fibrillation; brain hypoxia; hypertension; modified rankin scale (mrs); obstructive sleep apnea (osa).