Journal of Neurology

, Volume 261, Issue 2, pp 343–349 | Cite as

Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia

  • Jessica KepplingerEmail author
  • Kristian Barlinn
  • Amelia K. Boehme
  • Johannes Gerber
  • Volker Puetz
  • Lars-Peder Pallesen
  • Wiebke Schrempf
  • Imanuel Dzialowski
  • Karen C. Albright
  • Andrei V. Alexandrov
  • Heinz Reichmann
  • Ruediger von Kummer
  • Ulf Bodechtel
Original Communication


The aim of this study was to determine the importance of sleep apnea in relation to clinically silent microvascular brain tissue changes in patients with acute cerebral ischemia. Patients with acute cerebral ischemia prospectively underwent nocturnal respiratory polygraphy within 5 days from symptom-onset. Sleep apnea was defined as apnea–hypopnea-index (AHI) ≥5/h. Experienced readers blinded to clinical and sleep-related data reviewed brain computed tomography and magnetic resonance imaging scans for leukoaraiosis and chronic lacunar infarctions. Ischemic lesions were considered clinically silent when patients did not recall associated stroke-like symptoms. Functional outcome was assessed with modified Rankin Scale at discharge, 6 and 12 months. Fifty-one of 56 (91 %) patients had sleep apnea of any degree. Patients with moderate-to-severe leukoaraiosis (Wahlund score ≥5) were found to have higher mean AHI than those with none or mild leukoaraiosis (34.4 vs. 12.8/h, p < 0.001). Moderate-to-severe sleep apnea (AHI ≥15/h) was found to be an independent predictor of moderate-to-severe leukoaraiosis (adjusted OR 6.03, 95 % CI 1.76–20.6, p = 0.0042) and of moderate-to-severe leukoaraiosis associated with clinically silent chronic lacunar infarctions (adjusted OR 10.5, 95 % CI 2.19–50.6, p = 0.003). The higher the Wahlund score and the AHI, the more likely unfavorable functional outcome resulted over time (p = 0.0373). In acute cerebral ischemia, sleep apnea is associated with clinically silent microvascular brain tissue changes and may negatively influence functional outcome. Routine sleep apnea screening and further investigation of possible long-term effects of non-invasive ventilatory treatment of sleep apnea appear warranted in this at-risk population.


Acute stroke Silent brain infarction Sleep apnea Leukoaraiosis 



Weinmann Medical Technology, Hamburg, Germany provided the SOMNOCheck effort® device free of charge for this study.

Conflicts of interest

The authors declare that they have no conflict of interest


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jessica Kepplinger
    • 1
    Email author
  • Kristian Barlinn
    • 1
    • 2
  • Amelia K. Boehme
    • 3
  • Johannes Gerber
    • 4
  • Volker Puetz
    • 1
  • Lars-Peder Pallesen
    • 1
  • Wiebke Schrempf
    • 1
  • Imanuel Dzialowski
    • 1
    • 5
  • Karen C. Albright
    • 2
    • 3
  • Andrei V. Alexandrov
    • 2
  • Heinz Reichmann
    • 1
  • Ruediger von Kummer
    • 4
  • Ulf Bodechtel
    • 1
  1. 1.Department of Neurology, Dresden University Stroke CenterUniversity of Technology DresdenDresdenGermany
  2. 2.Comprehensive Stroke CenterUniversity of Alabama HospitalBirminghamUSA
  3. 3.Department of Epidemiology, School of Public HealthUniversity of Alabama HospitalBirminghamUSA
  4. 4.Division of Neuroradiology, Dresden University Stroke CenterUniversity of Technology DresdenDresdenGermany
  5. 5.Elblandklinikum Meissen, Department of Neurology, Academic Teaching HospitalUniversity of Technology DresdenDresdenGermany

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