Atherosclerosis and obstructive sleep apnea in patients with ischemic stroke.
BACKGROUND
Of late, obstructive sleep apnea (OSA) has been suggested to be a risk factor for atherosclerotic artery disease. In the present study, we analyzed the prevalence of atherosclerosis in stroke patients with and without OSA.


METHODS
Two hundred and fourteen consecutive patients with ischemic stroke were included in this study. Patients were screened for classical cerebrovascular risk factors. All patients received a cardiorespiratory polygraphy to determine the apnea-hypopnea index. Duplex ultrasonography was used to evaluate the carotid bulb and the internal carotid artery for the presence of atherosclerotic lesions, which were graded in 'none', 'plaques with <50% stenosis', 'stenosis > or =50% to subtotal', and 'occlusion'.


RESULTS
Atherosclerotic lesions were identified in 42% of patients. These were significantly more prevalent in patients with OSA than in patients without. In multiple logistic regression analysis, this association was independent of other known vascular risk factors. Arterial hypertension, which was significantly related to atherosclerosis in univariate analysis, lost its statistical impact in multivariate analysis.


CONCLUSIONS
This study confirms that OSA is an independent risk factor for atherosclerotic artery disease that may even outweigh the impact of arterial hypertension in selected patient collectives. To further elucidate this topic, treatment studies are needed that look for a possible improvement of markers and signs of atherosclerosis in patients with OSA.
Dziewas
Rainer
R
Department of Neurology, University Hospital of Munster, Munster, Germany. dziewas@uni-muenster.de
Ritter
Martin
M
Usta
Nesrin
N
Boentert
Matthias
M
Hor
Hyon
H
Dittrich
Ralf
R
Schäbitz
Wolf R
WR
Ringelstein
E Bernd
EB
Young
Peter
P
D000208:Acute Disease; D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D018615:Ultrasonography, Doppler, Color