SAS-CARE-1 study: stroke topography and polysomnography-based respiratory sleep characteristics

Sleep-disordered breathing (SDB) is a risk factor of ischemic stroke but can also appear "de novo" after the acute brain damage. The link between SDB and stroke topography, which remains controversial, was assessed in this study.

This is a post-hoc analysis of the multicenter prospective SAS-CARE-1 study, which included 259 patients with acute stroke or transient ischemic attack. Assessments comprised demographics, medical history, and brain magnetic resonance imaging (MRI) at admission. In 101 patients with acute stroke, MRI-based stroke topography was binary coded for the involvement as supra- (cortical and/or subcortical) and/or infratentorial (brainstem and/or cerebellar) locations. Polysomnography was performed at admission (n = 101) and at 3 months post-stroke (n = 72).

A linear regression with adjustments for age and sex identified an association of brainstem stroke with a higher obstructive apnea index (OAI; 9.91 events/h for brainstem stroke versus no brainstem involvement, p = 0.003) at acute stroke, but not at 3 months post-stroke. Correspondingly, the decrease of OAI from acute to 3 months post-stroke was associated with brainstem (-10.72 events/h, p = 0.011) stroke with adjustment for age and sex. However, this association was not significant with an additional adjustment for baseline OAI. There were no other significant associations.

This study confirms the previously reported association between brainstem stroke and obstructive apneas. Further research is needed to elucidate the link between focal brain damage and respiratory control during sleep.