New York Medical College School of Medicine, Valhalla, New York, USA.
Westchester Medical Center, Valhalla, New York, USA.
J Neurointerv Surg. 2022 Dec;14(12):1195-1199. doi: 10.1136/neurintsurg-2021-018161. Epub 2021 Dec 20.
BackgroundObstructive sleep apnea (OSA) portends increased morbidity and mortality following acute ischemic stroke (AIS). Evaluation of OSA in the setting of AIS treated with endovascular mechanical thrombectomy (MT) has not yet been evaluated in the literature.
The National Inpatient Sample from 2010 to 2018 was utilized to identify adult AIS patients treated with MT. Those with and without OSA were compared for clinical characteristics, complications, and discharge disposition. Multivariable logistic regression analysis and propensity score adjustment (PA) were employed to evaluate independent associations between OSA and clinical outcome.
Among 101 093 AIS patients treated with MT, 6412 (6%) had OSA. Those without OSA were older (68.5 vs 65.6 years old, p<0.001), female (50.5% vs 33.5%, p<0.001), and non-caucasian (29.7% vs 23.7%, p<0.001). The OSA group had significantly higher rates of obesity (41.4% vs 10.5%, p<0.001), atrial fibrillation (47.1% vs 42.2%, p=0.001), hypertension (87.4% vs 78.5%, p<0.001), and diabetes mellitus (41.2% vs 26.9%, p<0.001). OSA patients treated with MT demonstrated lower rates of intracranial hemorrhage (19.1% vs 21.8%, p=0.017), treatment of hydrocephalus (0.3% vs 1.1%, p=0.009), and in-hospital mortality (9.7% vs 13.5%, p<0.001). OSA was independently associated with lower rate of in-hospital mortality (aOR 0.76, 95% CI 0.69 to 0.83; p<0.001), intracranial hemorrhage (aOR 0.88, 95% CI 0.83 to 0.95; p<0.001), and hydrocephalus (aOR 0.51, 95% CI 0.37 to 0.71; p<0.001). Results were confirmed by PA.
Our findings suggest that MT is a viable and safe treatment option for AIS patients with OSA.
阻塞性睡眠呼吸暂停（OSA）预示着急性缺血性脑卒中（AIS）后发病率和死亡率增加。在接受血管内机械血栓切除术（MT）治疗的 AIS 患者中，尚未对 OSA 的评估进行文献评估。
利用 2010 年至 2018 年的国家住院患者样本，确定接受 MT 治疗的成年 AIS 患者。比较有无 OSA 的患者的临床特征、并发症和出院情况。采用多变量逻辑回归分析和倾向评分调整（PA）来评估 OSA 与临床结局之间的独立关联。
在 101093 例接受 MT 治疗的 AIS 患者中，有 6412 例（6%）患有 OSA。无 OSA 的患者年龄更大（68.5 岁比 65.6 岁，p<0.001），女性比例更高（50.5%比 33.5%，p<0.001），非白种人比例更高（29.7%比 23.7%，p<0.001）。OSA 组肥胖（41.4%比 10.5%，p<0.001）、心房颤动（47.1%比 42.2%，p=0.001）、高血压（87.4%比 78.5%，p<0.001）和糖尿病（41.2%比 26.9%，p<0.001）的发生率明显更高。接受 MT 治疗的 OSA 患者颅内出血发生率较低（19.1%比 21.8%，p=0.017）、脑积水治疗率较低（0.3%比 1.1%，p=0.009）、院内死亡率较低（9.7%比 13.5%，p<0.001）。OSA 与较低的院内死亡率（优势比 0.76，95%置信区间 0.69 至 0.83；p<0.001）、颅内出血（优势比 0.88，95%置信区间 0.83 至 0.95；p<0.001）和脑积水（优势比 0.51，95%置信区间 0.37 至 0.71；p<0.001）独立相关。PA 结果也证实了这一结果。
我们的研究结果表明，MT 是 OSA 患者 AIS 的一种可行且安全的治疗选择。
