MRI of the pharynx in ischemic stroke patients with and without obstructive sleep apnea.
BACKGROUND
Obstructive sleep apnea (OSA) is common after stroke and associated with poor stroke outcomes. Whether OSA after acute stroke is caused by anatomic, physiologic, or both etiologies has not been studied. We therefore used brain magnetic resonance imaging (MRI) scans to assess oropharyngeal anatomy in stroke patients with and without OSA.


METHODS
Patients within 7 days of ischemic stroke underwent nocturnal polysomnography. Sagittal T1-weighted MRI performed for clinical purposes was used to measure retropalatal distance, soft palatal length, soft palatal thickness, retroglossal space, and tongue length. Nasopharyngeal area and high retropharyngeal area were measured from axial T2-weighted images, and lateral pharyngeal wall thickness from coronal T1-weighted images.


RESULTS
Among 27 subjects, 18 (67%) had OSA (apnea/hypopnea index (AHI)5). Demographics, vascular risk factors, and stroke severity were similar in the two groups. Median retropalatal distance was shorter in subjects with OSA (Wilcoxon rank-sum test, p=0.03). Shorter retropalatal distance was associated with higher AHI (linear regression, p=0.04). None of the other morphological characteristics differed.


CONCLUSIONS
Anatomic difference between awake acute stroke patients with and without OSA shows that the sleep disorder cannot be attributed solely to sleep, sleeping position, or changes in neuromuscular control that are specific to the sleep state.
Brown
Devin L
DL
Stroke Program, University of Michigan Medical School, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA. devinb@umich.edu
Bapuraj
J Rajiv
JR
Mukherji
Suresh K
SK
Chervin
Ronald D
RD
Concannon
Maryann
M
Helman
Joseph I
JI
Lisabeth
Lynda D
LD
D000368:Aged; D000403:Airway Resistance / Q000502:physiology; D002544:Cerebral Infarction / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000473:pathology; D009929:Organ Size / Q000502:physiology; D010100:Oxygen / Q000097:blood; D010614:Pharynx / Q000473:pathology*; D017286:Polysomnography; D012372:ROC Curve; D012016:Reference Values; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D014851:Wakefulness / Q000502:physiology
D010100:Oxygen
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