Obstructive Sleep Apnea in Acute Stroke: A Role for Systemic Inflammation

Area of Science:

• Neurology
• Sleep Medicine
• Cardiovascular Research

Background:

• Sleep-disordered breathing (SDB) is highly prevalent in stroke patients, with obstructive sleep apnea (OSA) occurring 4-6 times more frequently.
• The association between OSA severity and inflammatory/coagulability markers in acute stroke remains under-explored.

Purpose of the Study:

• To prospectively evaluate clinical characteristics and laboratory markers of inflammation and coagulability in relation to OSA severity during the acute post-stroke period.

Main Methods:

• Prospective evaluation of consecutive acute ischemic stroke patients within 48 hours of symptom onset.
• Utilized Watch peripheral arterial tonometry for ambulatory sleep studies.
• Measured serum levels of tumor necrosis factor, interleukin-6, and plasminogen activator inhibitor-1.

Main Results:

• 86% of patients had SDB (apnea hypopnea index [AHI]≥5), with 32.5% having severe OSA (AHI≥30).
• Patients with OSA (AHI≥15) showed significantly higher levels of tumor necrosis factor, interleukin-6, and plasminogen activator inhibitor-1 compared to those without.
• Higher AHI was directly correlated with increased inflammatory and coagulability biomarkers.

Conclusions:

• Almost 90% of unselected acute ischemic stroke patients exhibit SDB, with a third experiencing severe OSA.
• SDB in stroke patients is associated with elevated inflammatory biomarkers, offering a potential pathophysiological link to stroke risk.
• These findings support routine screening for SDB in stroke patients and suggest a basis for interventional trials.