Coexistence of obstructive sleep apnea worsens the overall outcome of intracranial aneurysm: a pioneer study.
OBJECTIVE Obstructive sleep apnea (OSA) is associated with the progression of abdominal and thoracic aortic aneurysms. However, the role of OSA in the overall outcome of intracranial aneurysms (IAs) has not yet been established. Authors of this report investigated the role of OSA in the overall outcome of IAs. METHODS Radiological and clinical data on patients (from 2010 through 2015) with confirmed IA were retrospectively reviewed. Significant differences between the OSA and non-OSA groups were determined using a chi-square test. Logistic regression analysis was performed to identify the predictors of an unfavorable IA outcome. RESULTS Among the 283 patients with confirmed IAs, 45 patients (16%) were positively screened for OSA, a proportion that was significantly higher than the prevalence of OSA in nonaneurysmal neurosurgical patients (4%, p = 0.008). The percentage of patients with hypertension (p = 0.018), a body mass index ≥ 30 kg/m2(p < 0.0001), hyperlipidemia (p = 0.034), diabetes mellitus (p = 0.005), chronic heart disease (CHD; p = 0.024), or prior stroke (p = 0.03) was significantly higher in the OSA group than in the non-OSA group. Similarly, the percentage of wide-necked aneurysms (p = 0.00001) and patients with a poor Hunt and Hess Grade IV-V (p = 0.01) was significantly higher in the OSA group than in the non-OSA group. In addition, the percentage of ruptured aneurysms (p = 0.03) and vasospasms (p = 0.03) was significantly higher in the OSA group. The percentage of patients with poor modified Rankin Scale (mRS) scores (3-6) was significantly higher in the OSA group (p = 0.03). A separate cohort of patients with ruptured IAs showed similar results. In both univariate (p = 0.01) and multivariate (p = 0.04) regression analyses, OSA was identified as an individual predictor of an unfavorable outcome. In addition, hypertension and prior stroke were revealed as predictors of a poor IA outcome. CONCLUSIONS Complications of IA such as rupture and vasospasm are often the consequence of uncontrolled OSA. Overall outcome (mRS) of IAs is also affected by the co-occurrence of OSA. Therefore, the coexistence of OSA with IA affects the outcome of IAs. Obstructive sleep apnea is a risk factor for a poor outcome in IA patients.
2Neurosurgery, LSU Health-Shreveport, Louisiana.
Shyamal C
SC
Bir
2Neurosurgery, LSU Health-Shreveport, Louisiana.
Anil
A
Nanda
2Neurosurgery, LSU Health-Shreveport, Louisiana.
Hugo
H
Cuellar
2Neurosurgery, LSU Health-Shreveport, Louisiana.
Hai
H
Sun
2Neurosurgery, LSU Health-Shreveport, Louisiana.
Bharat
B
Guthikonda
Departments of1Neurology and Sleep Medicine and.
Cesar
C
Liendo
Departments of1Neurology and Sleep Medicine and.
Alireza
A
Minagar
Departments of1Neurology and Sleep Medicine and.
Oleg Y
OY
Chernyshev
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000000981:diagnostic imaging; D055815:Young Adult
CHD = chronic heart disease; CPAP = continuous positive airway pressure; DM = diabetes mellitus; EPC = endothelial progenitor cell; HH = Hunt and Hess; IA = intracranial aneurysm; MRA = MR angiography; NO = nitric oxide; OSA = obstructive sleep apnea; PSG = polysomnography; VP = ventriculoperitoneal; cerebral aneurysms; comorbidities; mRS = modified Rankin Scale; obstructive sleep apnea; outcome; rupture; vascular disorders; vasospasm