Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Stroke Program - Cardiovascular Center, Department of Neurology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
Sleep Med. 2021 May;81:158-162. doi: 10.1016/j.sleep.2021.02.010. Epub 2021 Feb 10.
OBJECTIVE/BACKGROUND: Obstructive sleep apnea is a risk factor for stroke. This study sought to assess the relationship between obstructive sleep apnea (OSA) and wake-up strokes (WUS), that is, stroke symptoms that are first noted upon awakening from sleep.
PATIENTS/METHODS: In this analysis, 837 Brain Attack Surveillance in Corpus Christi (BASIC) project participants completed an interview to ascertain stroke onset during sleep (WUS) versus wakefulness (non-wake-up stroke, non-WUS). A subset of 316 participants underwent a home sleep apnea test (HSAT) shortly after ischemic stroke to assess for OSA. Regression models were used to test the association between OSA and WUS, stratified by sex.
Of 837 participants who completed the interview, 251 (30%) reported WUS. Among participants who underwent an HSAT, there was no significant difference in OSA severity [respiratory event index (REI)] among participants with WUS [median REI 17, interquartile range (IQR) 10, 29] versus non-WUS (median REI 18, IQR 9, 30; p = 0.73). OSA severity was not associated with increased odds of WUS among men [unadjusted odds ratio (OR) 1.011, 95% confidence interval (95% CI) 0.995, 1.027] or women (unadjusted OR 0.987, 95% CI 0.959, 1.015). These results remained unchanged after adjustment for age, congestive heart failure, body mass index, and pre-stroke depression in men (adjusted OR 1.011, 95% CI 0.994, 1.028) and women (adjusted OR 0.988, 95% CI 0.959, 1.018).
Although OSA is a risk factor for stroke, the onset of stroke during sleep is not associated with OSA in this large, population-based stroke cohort.
目的/背景：阻塞性睡眠呼吸暂停是中风的一个危险因素。本研究旨在评估阻塞性睡眠呼吸暂停（OSA）与觉醒性中风（WUS）之间的关系，即首先在睡眠中醒来时出现的中风症状。
患者/方法：在这项分析中，837 名 Brain Attack Surveillance in Corpus Christi（BASIC）项目参与者完成了一项访谈，以确定睡眠中（WUS）与清醒时（非觉醒性中风，非 WUS）的中风发作情况。316 名参与者的一部分在缺血性中风后不久接受了家庭睡眠呼吸暂停测试（HSAT），以评估 OSA。回归模型用于测试 OSA 与 WUS 之间的关联，按性别分层。
在完成访谈的 837 名参与者中，有 251 名（30%）报告了 WUS。在接受 HSAT 的参与者中，WUS 参与者的 OSA 严重程度[呼吸事件指数（REI）]与非 WUS 参与者无显著差异[中位数 REI 为 17，四分位距（IQR）为 10，29]；（中位数 REI 为 18，IQR 为 9，30；p=0.73）。在男性[未调整的优势比（OR）1.011，95%置信区间（95%CI）0.995，1.027]或女性[未调整的 OR 0.987，95%CI 0.959，1.015]中，OSA 严重程度与 WUS 的几率增加无关。这些结果在男性（调整后的 OR 1.011，95%CI 0.994，1.028）和女性（调整后的 OR 0.988，95%CI 0.959，1.018）中，在调整年龄、充血性心力衰竭、体重指数和中风前抑郁后仍然不变。
尽管 OSA 是中风的一个危险因素，但在这个大型基于人群的中风队列中，睡眠中中风的发作与 OSA 无关。
