INFLUENCE OF SLEEP APNEA ON ONE YEAR OUTCOME OF ACUTE STROKE

Abstract

The aim was to determine whether sleep apnea affects the outcome of stroke patients according to the sex, age, type, and side of stroke. 

Patients and Methods: It was analyzed 110 acute stroke patients with sleep apnea. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. There was no significant difference in patient's age with or without sleep apnea neither in men nor women. Neurological, neuropsychiatric, pulmonary tests were performed in all patients at five different periods. In these periods, all patients were evaluated: The American National Institutes of Health Scale Assessment, Mini-Mental Test, The Sleep and snoring Questionnaire Test, The Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale, and The general sleep questionnaire. Statistical data was analyzed by Arcus Quickstat Biomedical statistical program with p<0.05 considered significant.

Results: One year after the onset of stroke, 91 (82.7%) of 110 patients with apnea survived. The survival rate of patients with sleep apnea is significantly lower than without sleep apnea (p = 0.01). In men with apnea, the survival rate was significantly lower in patients without apnea (p = 0.004). Survival of both gender in patients with apnea (22. 64.7%) was the lowest in groups older than 70 years of age. Sex ratio (men-women) was 15 (68.2%): 7 (58.3%). Survival in both gender in patients without apnea was the same in group older than 70 years of age: 27 (81.2%) out of 33. The average age of patients who died with apnea was significantly higher than patients without (t = 1.97, p = 0.03). One year after stroke survived 78 (84.8%) patients out of 92 with apnea and ischemic stroke (IS). Otherwise, 13 (72.2%) patients survived out of 18 with hemorrhagic stroke (HS). Without apnea 88 (95.7%) patients who survived had IS and 16 (88.9%) HS. Survival of patients with IS and without apnea is significantly better than in patients with IS and apnea (X² =5.46, p = 0.02). Survival of patients with HS with/without apnea is not significantly different. Concerning the side of stroke, 23 (88.5%) patients with apnea who survived had a lesion(s) in the left hemisphere but this difference is not significant. Patients without apnea 48 (96%) had lesion(s) at both sides. 

Conclusion: Patients with sleep apnea have a significant correlation in survival rates compared with sexually and age-matched subjects. Survival of patients without apnea in ischemic stroke is significantly better than in patients with apnea, but survival in patients with/without apnea in hemorrhagic stroke has no statistical difference. The side of the lesion does not influence survival rates.