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(Stroke. 2003;34:2916.)
© 2003 American Heart Association, Inc.

Original Contributions

Sleep-Disordered Breathing as a Risk Factor for Cerebrovascular Disease

A Case-Control Study in Patients With Transient Ischemic Attacks

Nigel McArdle, MD; Renata L. Riha, MD; Marjorie Vennelle; Emma L. Coleman; Martin S. Dennis, MD; Charles P. Warlow, MD Neil J. Douglas, MD

From the Department of Medicine (N.M., R.L.R., M.V., E.L.C., N.J.D.), University of Edinburgh, Royal Infirmary, Edinburgh, UK; Department of Medicine (N.M.), University of Western Australia, Royal Perth Hospital, Perth, Australia; and Department of Clinical Neurosciences (M.S.D., C.P.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK.

Correspondence to Prof Neil J. Douglas, Dept of Medicine, The University of Edinburgh, Royal Infirmary, Lauriston Place, Edinburgh EH3 9YW, UK. E-mail n.j.douglas{at}ed.ac.uk

Background and Purpose— The evidence that obstructive sleep apnea/hypopnea (OSAH) is a risk factor for ischemic cerebrovascular disease is inconclusive. We explored this relationship in transient ischemic attack (TIA) patients because they are less likely than stroke patients to have OSAH as a consequence of cerebrovascular disease.

Methods— We performed a case-control study among 86 patients with TIA from a hospital neurovascular clinic, matched for age (±5 years) and sex with controls from the referring local family practice registers.

Results— Forty-nine of the 86 matched pairs were male and the body mass index was similar among cases and controls. The primary outcome measure, the apnea/hypopnea index [AHI=number of (apneas+hypopneas)/h slept, measured during overnight polysomnography and scored blind to case-control status], was the same for cases and controls (21/hour). However, the median number of 4% desaturations during sleep was slightly greater in the cases (12/hour) than controls (6/hour, P=0.04). There were the expected associations between TIA and higher fibrinogen levels (TIA 3.3, control 3.0 g/L, P=0.01), previous myocardial infarction (TIA 22, control 6%, P=0.007), a history of ever smoking (TIA 71, control 54%, P=0.01), hypertension (TIA 51, control 21%, P=0.001), and raised cholesterol (TIA 27, control 10%, P=0.01), with a weak trend for diabetes mellitus (TIA 10, control 6%, P=0.4).

Conclusion— OSAH does not appear to be strongly associated with TIAs.

Key Words: cerebral ischemia, transient • cerebrovascular disorders • sleep apnea syndromes

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