Devenish Adriana N, Nisar Tariq, Criswell Amber, McCane David, Thao Dinh, Ling Ken Chyuan, Chiu David, Gadhia Rajan
Neurological Institute, Houston Methodist Hospital, Houston, USA.
Neurology, Houston Methodist Hospital, Houston, USA.
Cureus. 2023 May 29;15(5):e39652. doi: 10.7759/cureus.39652. eCollection 2023 May.
Background Obstructive sleep apnea (OSA) is characterized by repeated episodes of either full or partial obstruction of the upper airway. OSA is an independent risk factor for acute ischemic stroke (AIS) and a contributor to other key risk factors. OSA may damage endothelial and brain tissues and worsen outcomes following AIS. We aimed to evaluate the impact of sex differences on 90-day functional outcomes following AIS in an OSA population, as measured by the modified Rankin Scale (mRS) score. Methodology We performed a retrospective study of patients with OSA and AIS from the Houston Methodist Hospital Outcomes-Based Prospective Endpoints in Stroke (HOPES) Registry from 2016 to 2022. Patients with charts that noted a diagnosis of OSA before AIS or within the 90 days following AIS were included. A multivariable logistic regression model was constructed adjusting for demographics, first admit National Institutes of Health Stroke Scale (NIHSS), and comorbidities on the binary outcome. The odds ratios (ORs) and 95% confidence intervals (CIs) were reported, providing likelihood estimates of a shift to higher mRS for a given comparison between females (reference category) and males. Statistical significance was defined as two-tailed p-values <0.05 for all tests. Results From the HOPES registry, 291 females and 449 males were found to have OSA. Males had a higher proportion of comorbid conditions such as atrial fibrillation (15% vs. 9%, p = 0.014) and intracranial hemorrhage compared to females (6% vs. 2%, p = 0.020). The multivariate logistic regression model showed that males were at two times higher risk for developing poor functional outcomes at 90 days (OR = 2.35, 95% CI = 1.06-5.19), p < 0.001). Conclusions Males were found to have two times higher risk for developing poor functional outcomes at 90 days. This may be due to more severe oxygen desaturation, increased susceptibility to oxidative stress, and greater frequency of full airway obstruction in males. Greater emphasis on early diagnosis and treatment of OSA may be necessary to reduce the disproportionate incidence of poor functional outcomes, particularly among apneic male stroke survivors.
阻塞性睡眠呼吸暂停（OSA）的特征是上呼吸道反复出现完全或部分阻塞发作。OSA是急性缺血性卒中（AIS）的独立危险因素，也是其他关键危险因素的促成因素。OSA可能会损害内皮组织和脑组织，并使AIS后的预后恶化。我们旨在评估性别差异对OSA人群中AIS后90天功能预后的影响，采用改良Rankin量表（mRS）评分进行测量。
我们对2016年至2022年休斯顿卫理公会医院基于卒中结局的前瞻性终点（HOPES）登记处的OSA和AIS患者进行了一项回顾性研究。纳入在AIS之前或AIS后90天内病历记录有OSA诊断的患者。构建多变量逻辑回归模型，对人口统计学、首次入院时的美国国立卫生研究院卒中量表（NIHSS）和二元结局的合并症进行调整。报告优势比（OR）和95%置信区间（CI），给出女性（参照类别）和男性之间给定比较时mRS升高的可能性估计。所有检验的统计学显著性定义为双侧p值<0.05。
从HOPES登记处发现，291名女性和449名男性患有OSA。与女性相比，男性合并症如心房颤动（15%对9%，p = 0.014）和颅内出血的比例更高（6%对2%，p = 0.020）。多变量逻辑回归模型显示，男性在90天时出现功能预后不良的风险高出两倍（OR = 2.35，95%CI = 1.06 - 5.19），p < 0.001）。
发现男性在90天时出现功能预后不良的风险高出两倍。这可能是由于男性更严重的氧饱和度下降、对氧化应激的易感性增加以及完全气道阻塞的频率更高。可能有必要更加强调OSA的早期诊断和治疗，以降低功能预后不良的不成比例发生率，特别是在呼吸暂停的男性卒中幸存者中。
