title: Infarct location and sleep apnea: evaluating the potential association in acute ischemic stroke.
abstract: BACKGROUND
  The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events.
  
  
  METHODS
  Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI.
  
  
  RESULTS
  Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence.
  
  
  CONCLUSIONS
  These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients.
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. Electronic address: Stephanie.Stahl@va.gov.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Stahl
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
authors.forename: H Klar
authors.initials: HK
authors.lastname: Yaggi
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, IUPUI, Indianapolis, IN 46202, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Taylor
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06520, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Qin
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Cristina S
authors.initials: CS
authors.lastname: Ivan
authors.affiliation: VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Austin
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Radu
authors.initials: R
authors.lastname: Radulescu
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Tobias
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Sico
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Vaz Fragoso
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
authors.affiliation: VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Miech
authors.affiliation: VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA; Department of Communication Studies, Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN 46202, USA.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
authors.affiliation: Chicago Medical School, North Chicago, IL 60064, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kapoor
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Regenstrief Institute, Indianapolis, IN 46202, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D001921:Brain / Q000098:blood supply / Q000473:pathology; D020520:Brain Infarction / Q000150:complications* / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000209:etiology*
keywords: CT; Infarct; MRI; Sleep apnea; Stroke