Is obstructive sleep apnea associated with the presence of intracranial cerebral atherosclerosis?
OBJECTIVE
Intracranial cerebral atherosclerosis (ICAS) is one of critical atherosclerosis which closely related with stroke. Obstructive sleep apnea (OSA) is associated with systemic atherosclerosis, but it is unclear whether OSA is related with the presence of ICAS. We aimed to investigate the association between the presence of ICAS and severity of OSA in patients with suspected OSA.


METHODS
This retrospective, cross-sectional study included 283 patients who suspected OSA (presence of one or more OSA-related symptom and high-risk category in Berlin questionnaire) and underwent polysomnography and brain magnetic resonance angiography (MRA). The ICAS was defined as ≥50% decrease of luminal diameter in MRA. The severity of OSA was defined by apnea-hypopnea index (AHI).


RESULTS
The mean age was 60.7 ± 13.5 years, and 55.8% (158/283) were male in all included patients. The 53 (18.7%) patients had ICAS and 117 (41.3%) patients had moderate to severe OSA (AHI ≥ 15). Higher AHI was noted in patients with ICAS compared to those without ICAS (31.7 ± 25.8 versus 15.2 ± 17.4, p = 0.001). In multivariable logistic analyses, after adjusting for age, sex, and variables with p < 0.1 in univariable analyses (hypertension, diabetes mellitus, atrial fibrillation, previous stroke history, body mass index, lipid-lowing agents, arousal index, and minimum oxygen saturation), moderate to severe OSA were independently related with the presence of ICAS (odds ratio 4.17, 95% confidence interval 1.40-12.40, p = 0.010).


CONCLUSIONS
Our findings suggest that moderate to severe OSA is associated with the presence of ICAS in patients with suspected OSA.
Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.|Department of Medical Science, Ewha Womans University School of Medicine, Seoul, South Korea.
Tae-Jin
TJ
Song
Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
Jung-Hyun
JH
Park
Department of Medical Science, Ewha Womans University School of Medicine, Seoul, South Korea.|Ewha Medical Research Institute, Seoul, South Korea.
Kang Hyun
KH
Choi
Department of Medical Science, Ewha Womans University School of Medicine, Seoul, South Korea.|Ewha Medical Research Institute, Seoul, South Korea.
Ju-Hee
JH
Kim
Department of Medical Science, Ewha Womans University School of Medicine, Seoul, South Korea.|Ewha Medical Research Institute, Seoul, South Korea.
Yunseo
Y
Choi
Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
Yoonkyung
Y
Chang
Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.|Ewha Medical Research Institute, Seoul, South Korea.
Hyeon Jin
HJ
Kim
Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.|Department of Medical Science, Ewha Womans University School of Medicine, Seoul, South Korea.|Ewha Medical Research Institute, Seoul, South Korea.
Jangsup
J
Moon
Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.|Department of Medical Science, Ewha Womans University School of Medicine, Seoul, South Korea.
Yong-Jae
YJ
Kim
Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea. leeh@ewha.ac.kr.|Department of Medical Science, Ewha Womans University School of Medicine, Seoul, South Korea. leeh@ewha.ac.kr.|Ewha Medical Research Institute, Seoul, South Korea. leeh@ewha.ac.kr.
Hyang Woon
HW
Lee
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications*
Apnea-hypopnea index; Intracranial cerebral atherosclerosis; Obstructive sleep apnea