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Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
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2008 (English)In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 168, no 3, 297-301 p.Article in journal (Refereed) Published
Abstract [en]

 

Background: Sleep apnea occurs frequently among stroke patients, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality. We aimed to investigate whether obstructive or central sleep apnea was related to a reduced long-term survival among stroke patients.

Methods: One hundred and thirty-two of 151 patients admitted for in-hospital stroke rehabilitation in the catchment area of Umeå from 1 April 1995 to 1 May 1997 underwent overnight sleep apnea recordings at 23 ± 8 days after onset of stroke. All patients were followed-up prospectively for a mean (SD) of 10.0 ± 0.6 years, with death as the primary outcome and no one was lost to follow-up. Obstructive sleep apnea was defined when the obstructive apnea-hypopnea index was over 15 and central sleep apnea when the central apnea-hypopnea index was over 15. Patients with an obstructive and a central apnea-hypopnea index below 15 served as controls.

Results: Of 132 enrolled patients, 116 had died at follow-up. The risk of death was higher among the 23 patients with obstructive sleep apnea than controls (adjusted hazard ratio, 1.76; 95% confidence interval 1.05 to 2.95, p=0.03), independent of age, gender, body-mass index, smoking, hypertension, diabetes mellitus, atrial fibrillation, mini-mental state examination and Barthel activity of daily living There was no difference in mortality between the 28 patients with central sleep apnea and controls (adjusted hazard ratio, 1.07; 95 percent confidence interval 0.65 to 1.76, p=0.053).

Conclusions: Stroke patients with obstructive sleep apnea run an increased risk of early death. Central sleep apnea was not related to early death among the present patients.

Place, publisher, year, edition, pages
Chicago: American medical association , 2008. Vol. 168, no 3, 297-301 p.
Keyword [en]
obstructive sleep apnéa, stroke, death, positive airway pressure, Cheyne-Stokes respiration, breathing disorders, ischemic stroke, 1st-ever stroke, prognosis, disease, night
National Category
Cardiac and Cardiovascular Systems Family Medicine
Research subject
Lung Medicine
Identifiers
URN: urn:nbn:se:umu:diva-18814DOI: 10.1001/archinternmed.2007.70ISI: 000252962300009OAI: oai:DiVA.org:umu-18814DiVA: diva2:174854
Available from: 2009-02-25 Created: 2009-02-25 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Sleep apnea and sleep: diagnostic aspects
Open this publication in new window or tab >>Sleep apnea and sleep: diagnostic aspects
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients with sleep apnea have frequent apneas and hypopneas during sleep. Apneas can be either central or obstructive. The apnea-hypopnea index (AHI) is the mean number of apneas and hypopneas per hour of sleep.

Aims: 1) To evaluate the effect of a mandibular advancement device on obstructive apneas and sleep; 2) to evaluate the influence of body position on central apnea frequency; 3) to investigate whether obstructive or central apnea is related to mortality in patients with stroke; and 4) to investigate sleep and sleeping positions in women.

Methods: Subjects were investigated during whole-night sleep respiratory recordings, either polysomnography including continuous recordings of EEG, EOG, EMG, airflow, respiratory effort, ECG, pulse oximetry and body position, or simplified sleep apnea recordings without EEG, EOG and EMG.

Results: The frequency of obstructive apneas, hypopneas and arousals decreased and rapid eye movement (REM) sleep increased in patients with mild, moderate and severe sleep apnea during treatment with a mandibular advancement device.

Central apneas were more prevalent in the supine position compared with the non-supine position in patients with Cheyne-Stokes respiration. The mean ± SD central AHI was 41 ± 13 in the supine position and 26 ± 12 in the non-supine position, p<0.001.

Stroke patients with obstructive sleep apnea ran an increased risk of death during 10 ± 0.6 years of follow-up with an adjusted hazard ratio of 1.76 (95% CI 1.05-2.95) compared with controls, independent of hypertension, age, body mass index, gender, smoking, diabetes mellitus, atrial fibrillation, Mini-Mental State Examination and Barthel-ADL. Central apnea was not related to early death.

Total sleep time, sleep efficiency, rapid eye movement sleep, slow wave and time in the supine position decreased with age in women. Sleep quality in women was reduced with age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension.

Conclusions: Obstructive sleep apneas and arousals are reduced and REM sleep is increased using a mandibular advancement device in patients with mild, moderate and severe sleep apnea. The frequency of central apneas and hypopneas is increased in the supine position in patients with Cheyne-Stokes respiration. Stroke patients with obstructive sleep apnea run an increased risk of early death. Central sleep apnea was not related to early death among the present patients. Normal values for sleep stages and sleeping positions are presented in a population-based sample of women. Age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality in women.

Place, publisher, year, edition, pages
Umeå: Department of Public Health and Clinical Medicine, Respiratory Medicine and Allegy, 2009. 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1246
Keyword
Sleep apnea, sleep stages, snoring, stroke, polysomnography, Cheyne-Stokes respiration, supine-dependency
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-18959 (URN)978-91-7264-702-2 (ISBN)
Public defence
2009-04-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, 90185 Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-09 Created: 2009-03-02 Last updated: 2010-01-18Bibliographically approved

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Sahlin, CarinGustafson, YngveBucht, GöstaCarlberg, BoStenlund, HansFranklin, Karl

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