title: Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia.
abstract: The aim of this study was to determine the importance of sleep apnea in relation to clinically silent microvascular brain tissue changes in patients with acute cerebral ischemia. Patients with acute cerebral ischemia prospectively underwent nocturnal respiratory polygraphy within 5 days from symptom-onset. Sleep apnea was defined as apnea-hypopnea-index (AHI) ≥5/h. Experienced readers blinded to clinical and sleep-related data reviewed brain computed tomography and magnetic resonance imaging scans for leukoaraiosis and chronic lacunar infarctions. Ischemic lesions were considered clinically silent when patients did not recall associated stroke-like symptoms. Functional outcome was assessed with modified Rankin Scale at discharge, 6 and 12 months. Fifty-one of 56 (91 %) patients had sleep apnea of any degree. Patients with moderate-to-severe leukoaraiosis (Wahlund score ≥5) were found to have higher mean AHI than those with none or mild leukoaraiosis (34.4 vs. 12.8/h, p < 0.001). Moderate-to-severe sleep apnea (AHI ≥15/h) was found to be an independent predictor of moderate-to-severe leukoaraiosis (adjusted OR 6.03, 95 % CI 1.76-20.6, p = 0.0042) and of moderate-to-severe leukoaraiosis associated with clinically silent chronic lacunar infarctions (adjusted OR 10.5, 95 % CI 2.19-50.6, p = 0.003). The higher the Wahlund score and the AHI, the more likely unfavorable functional outcome resulted over time (p = 0.0373). In acute cerebral ischemia, sleep apnea is associated with clinically silent microvascular brain tissue changes and may negatively influence functional outcome. Routine sleep apnea screening and further investigation of possible long-term effects of non-invasive ventilatory treatment of sleep apnea appear warranted in this at-risk population.
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Fetscherstrasse 74, 01307, Dresden, Germany, jessica.kepplinger@uniklinikum-dresden.de.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepplinger
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.forename: Johannes
authors.initials: J
authors.lastname: Gerber
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.forename: Lars-Peder
authors.initials: LP
authors.lastname: Pallesen
authors.forename: Wiebke
authors.initials: W
authors.lastname: Schrempf
authors.forename: Imanuel
authors.initials: I
authors.lastname: Dzialowski
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.forename: Ruediger
authors.initials: R
authors.lastname: von Kummer
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D002196:Capillaries / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000473:pathology; D049292:Leukoaraiosis; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000473:pathology*; D059409:Stroke, Lacunar / Q000473:pathology; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult