Abstract 52: Brainstem Infarction is Associated with Sleep Apnea: The BASIC Sleep Project
Background: Despite hypotheses that brainstem infarction is associated with sleep apnea (SA), no specific site of infarction has been associated with post-stroke SA in existing studies, which have been relatively small. Within a larger, population-based study, we assessed the association between infarction location and SA presence and severity.
Methods: Ischemic stroke patients in the Brain Attack Surveillance in Corpus Christi (BASIC) project had SA screening performed (median 13 days after stroke) with a validated portable respiratory monitor (ApneaLink Plus) (n=355). The apnea-hypopnea index (AHI) was used to measure SA severity; SA was defined conservatively as an AHI ≥10. Acute infarction location was determined based on review of CT and MRI reports by board-certified neurologists and dichotomized into brainstem involvement or none. Logistic and linear regression models were used to test the associations between brainstem involvement and SA or AHI in unadjusted and adjusted models.
Results: Median age was 65 (IQR: 57, 77); 55% were male. Thirty-eight (11%) had acute infarction involving the brainstem. Of those without brainstem infarction, 59% had SA; the median AHI was 13 (interquartile range (IQR) 6, 26). Of those with brainstem infarction, 84% had SA; median AHI was 20 (IQR 11, 38). In unadjusted analysis, brainstem involvement was associated with over three times the odds of SA (OR 3.71 (95% CI: 1.52, 9.13). In a multivariable model, adjusted for demographics, BMI, stroke risk factors, and stroke severity, results were similar (OR 3.76 (95% CI: 1.44, 9.81)). Similarly, brainstem infarction was associated with AHI in unadjusted (p=0.004) and adjusted models (p=0.004).
Conclusion: Acute infarction involving the brainstem was associated with both presence and severity of sleep apnea in this population-based stroke surveillance study.
Author Disclosures: D.L. Brown: Research Grant; Significant; R01 NS062675, R01 HL098065, and R01 NS070941. M. McDermott: None. A. Mowla: None. R.D. Chervin: Research Grant; Significant; R01 NS070941, R01 HL098065, R01 HL105999, and R43 HL117421. Consultant/Advisory Board; Modest; unrestricted educational gifts to the University of Michigan from Philips Respironics and Fisher Paykel; advisory boards for the non-profit Sweet Dreamzzz and the NHLBI;. Other; Modest; consulted for Proctor &Gamble and Zansors; serves as a section editor for UpToDate. L.B. Morgenstern: Research Grant; Modest; St. Jude Medical. K.A. Kerber: Research Grant; Significant; R01DC012760. G. Hegeman: Research Grant; Significant; R01 HL098065. M.A. Smith: Research Grant; Significant; R01 NS38916, R01 NS062675, R01 HL098065. N.M. Garcia: Research Grant; Significant; R01 NS38916, R01 NS062675, R01 HL098065. L.D. Lisabeth: Research Grant; Significant; R01 NS38916, R01 NS062675, R01 HL098065, and R01 NS070941.
- © 2014 by American Heart Association, Inc.