title: Sleep Disordered Breathing and Risk of Stroke in Older Community-Dwelling Men.
abstract: OBJECTIVE
  Men with sleep disordered breathing (SDB) may be at increased stroke risk, due to nocturnal hypoxemia, sleep loss or fragmentation, or other mechanisms. We examined the association of SDB with risk of incident stroke in a large cohort of older men.
  
  
  METHODS
  Participants were 2,872 community-dwelling men (mean age 76 years) enrolled in the MrOS Sleep Study, which gathered data from 2003 to 2005 at six clinical sites in the Unites States. SDB predictors (obstructive apnea-hypopnea index, apnea-hypopnea index, central apnea index, and nocturnal hypoxemia) were measured using overnight polysomnography. Incident stroke over an average follow-up of 7.3 years was centrally adjudicated by physician review of medical records.
  
  
  RESULTS
  One hundred fifty-six men (5.4%) had a stroke during follow-up. After adjustment for age, clinic site, race, body mass index, and smoking status, older men with severe nocturnal hypoxemia (≥ 10% of the night with SpO2 levels below 90%) had a 1.8-fold increased risk of incident stroke compared to those without nocturnal hypoxemia (relative hazard = 1.83; 95% confidence interval 1.12-2.98; P trend = 0.02). Results were similar after further adjustment for other potential covariates and after excluding men with a history of stroke. Other indices of SDB were not associated with incident stroke.
  
  
  CONCLUSIONS
  Older men with severe nocturnal hypoxemia are at significantly increased risk of incident stroke. Measures of overnight oxygen saturation may better identify older men at risk for stroke than measures of apnea frequency.
authors.affiliation: California Pacific Medical Center Research Institute and San Francisco Coordinating Center, San Francisco, CA.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
authors.affiliation: California Pacific Medical Center Research Institute and San Francisco Coordinating Center, San Francisco, CA.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Blackwell
authors.affiliation: Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.affiliation: University of California, San Diego, CA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN; Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.affiliation: Department of Medicine, Stanford Prevention Research Center, Stanford University, Palo Alto, CA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hoffman
authors.affiliation: Sleep Center, Neurologic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland OH.
authors.forename: Reena
authors.initials: R
authors.lastname: Mehra
authors.affiliation: Department of Medicine, Stanford Prevention Research Center, Stanford University, Palo Alto, CA.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.affiliation: University of Colorado at Denver, Denver, CO.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
authors.affiliation: Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, San Francisco, CA and the San Francisco VA Medical Center, San Francisco, CA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology*; D008297:Male; D017286:Polysomnography; D012306:Risk; D012891:Sleep Apnea Syndromes / Q000453:epidemiology* / Q000503:physiopathology; D012892:Sleep Deprivation / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: nocturnal hypoxemia; sleep disordered breathing; stroke