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Am J Respir Crit Care Med. 2005 Dec 1;172(11):1447-51. Epub 2005 Sep 1.

Association of sleep-disordered breathing and the occurrence of stroke.

Author information

1
Toronto General Hospital/University Health Network, 9N-943, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.

Abstract

RATIONALE:

Sleep-disordered breathing has been linked to stroke in previous studies. However, these studies either used surrogate markers of sleep-disordered breathing or could not, due to cross-sectional design, address the temporal relationship between sleep-disordered breathing and stroke.

OBJECTIVES:

To determine whether sleep-disordered breathing increases the risk for stroke.

METHODS:

We performed cross-sectional and longitudinal analyses on 1,475 and 1,189 subjects, respectively, from the general population. Sleep-disordered breathing was defined by the apnea-hypopnea index (frequency of apneas and hypopneas per hour of sleep) obtained by attended polysomnography. The protocol, including polysomnography, risk factors for stroke, and a history of physician-diagnosed stroke, was repeated at 4-yr intervals.

MEASUREMENTS AND MAIN RESULTS:

In the cross-sectional analysis, subjects with an apnea-hypopnea index of 20 or greater had increased odds for stroke (odds ratio, 4.33; 95% confidence interval, 1.32-14.24; p = 0.02) compared with those without sleep-disordered breathing (apnea-hypopnea index, <5) after adjustment for known confounding factors. In the prospective analysis, sleep-disordered breathing with an apnea-hypopnea index of 20 or greater was associated with an increased risk of suffering a first-ever stroke over the next 4 yr (unadjusted odds ratio, 4.31; 95% confidence interval, 1.31-14.15; p = 0.02). However, after adjustment for age, sex, and body mass index, the odds ratio was still elevated, but was no longer significant (3.08; 95% confidence interval, 0.74-12.81; p = 0.12).

CONCLUSIONS:

These data demonstrate a strong association between moderate to severe sleep-disordered breathing and prevalent stroke, independent of confounding factors. They also provide the first prospective evidence that sleep-disordered breathing precedes stroke and may contribute to the development of stroke.

PMID:
16141444
PMCID:
PMC2718439
DOI:
10.1164/rccm.200505-702OC
[Indexed for MEDLINE]
Free PMC Article

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