title: Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study.
abstract: BACKGROUND
  Association between cerebral infarction site and poststroke sleep-disordered breathing (SDB) has important implications for SDB screening and the pathophysiology of poststroke SDB. Within a large, population-based study, we assessed whether brainstem infarction location is associated with SDB presence and severity.
  
  
  METHODS
  Cross-sectional study was conducted on ischemic stroke patients in the Brain Attack Surveillance in Corpus Christi (BASIC) project. Subjects underwent SDB screening (median 13days after stroke) with a well-validated cardiopulmonary sleep apnea-testing device (n=355). Acute infarction location was determined based on review of radiology reports and dichotomized into brainstem involvement or none. Logistic and linear regression models were used to test the associations between brainstem involvement and SDB or apnea/hypopnea index (AHI) in unadjusted and adjusted models.
  
  
  RESULTS
  A total of 38 participants (11%) had acute infarction involving the brainstem. Of those without brainstem infarction, 59% had significant SDB (AHI⩾10); the median AHI was 13 (interquartile range (IQR) 6, 26). Of those with brainstem infarction, 84% had SDB; median AHI was 20 (IQR 11, 38). In unadjusted analysis, brainstem involvement was associated with over three times the odds of SDB (odds ratio (OR) 3.71 (95% confidence interval (CI): 1.52, 9.13)). In a multivariable model, adjusted for demographics, body mass index (BMI), hypertension, diabetes, coronary artery disease, atrial fibrillation, prior stroke/transient ischemic attack (TIA), and stroke severity, results were similar (OR 3.76 (95% CI: 1.44, 9.81)). Brainstem infarction was also associated with AHI (continuous) in unadjusted (p=0.004) and adjusted models (p=0.004).
  
  
  CONCLUSIONS
  Data from this population-based stroke study show that acute infarction involving the brainstem is associated with both presence and severity of SDB.
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA. Electronic address: devinb@umich.edu.
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
authors.forename: Mollie
authors.initials: M
authors.lastname: McDermott
authors.affiliation: Department of Neurology, 100 High Street, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Mowla
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: De Lott
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA; Department of Epidemiology, 1014 SPH I, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Kerber
authors.affiliation: Sleep Disorders Center, University of Michigan, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109-5845, USA.
authors.forename: Garnett
authors.initials: G
authors.lastname: Hegeman
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Smith
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
authors.forename: Nelda M
authors.initials: NM
authors.lastname: Garcia
authors.affiliation: Sleep Disorders Center, University of Michigan, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109-5845, USA.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA; Department of Epidemiology, 1014 SPH I, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D020526:Brain Stem Infarctions / Q000150:complications*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000209:etiology*; D020521:Stroke / Q000150:complications
keywords: Brainstem; Infarction; Portable monitor; Risk factor; Sleep-disordered breathing; Stroke