title: Atherosclerosis and obstructive sleep apnea in patients with ischemic stroke.
abstract: 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.
authors.affiliation: Department of Neurology, University Hospital of Munster, Munster, Germany. dziewas@uni-muenster.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
authors.forename: Martin
authors.initials: M
authors.lastname: Ritter
authors.forename: Nesrin
authors.initials: N
authors.lastname: Usta
authors.forename: Matthias
authors.initials: M
authors.lastname: Boentert
authors.forename: Hyon
authors.initials: H
authors.lastname: Hor
authors.forename: Ralf
authors.initials: R
authors.lastname: Dittrich
authors.forename: Wolf R
authors.initials: WR
authors.lastname: Schäbitz
authors.forename: E Bernd
authors.initials: EB
authors.lastname: Ringelstein
authors.forename: Peter
authors.initials: P
authors.lastname: Young
mesh_terms: 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