title: Obstructive sleep apnea as a risk factor for stroke and death.
abstract: BACKGROUND
  Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently related to the risk of stroke or death from any cause after adjustment for other risk factors, including hypertension.
  
  
  METHODS
  In this observational cohort study, consecutive patients underwent polysomnography, and subsequent events (strokes and deaths) were verified. The diagnosis of the obstructive sleep apnea syndrome was based on an apnea-hypopnea index of 5 or higher (five or more events per hour); patients with an apnea-hypopnea index of less than 5 served as the comparison group. Proportional-hazards analysis was used to determine the independent effect of the obstructive sleep apnea syndrome on the composite outcome of stroke or death from any cause.
  
  
  RESULTS
  Among 1022 enrolled patients, 697 (68 percent) had the obstructive sleep apnea syndrome. At baseline, the mean apnea-hypopnea index in the patients with the syndrome was 35, as compared with a mean apnea-hypopnea index of 2 in the comparison group. In an unadjusted analysis, the obstructive sleep apnea syndrome was associated with stroke or death from any cause (hazard ratio, 2.24; 95 percent confidence interval, 1.30 to 3.86; P=0.004). After adjustment for age, sex, race, smoking status, alcohol-consumption status, body-mass index, and the presence or absence of diabetes mellitus, hyperlipidemia, atrial fibrillation, and hypertension, the obstructive sleep apnea syndrome retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95 percent confidence interval, 1.12 to 3.48; P=0.01). In a trend analysis, increased severity of sleep apnea at baseline was associated with an increased risk of the development of the composite end point (P=0.005).
  
  
  CONCLUSIONS
  The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, Conn 06520, USA.
authors.forename: H Klar
authors.initials: HK
authors.lastname: Yaggi
authors.forename: John
authors.initials: J
authors.lastname: Concato
authors.forename: Walter N
authors.initials: WN
authors.lastname: Kernan
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Brass
authors.forename: Vahid
authors.initials: V
authors.lastname: Mohsenin
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011336:Probability; D016016:Proportional Hazards Models; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000401:mortality; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D016019:Survival Analysis