Is obstructive sleep apnea associated with the presence of intracranial cerebral atherosclerosis?
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Intracranial cerebral atherosclerosis (ICAS) is one of critical atherosclerosis which closely related with stroke. Obstructive sleep apnea (OSA) is associated with systemic atherosclerosis, but it is unclear whether OSA is related with the presence of ICAS. We aimed to investigate the association between the presence of ICAS and severity of OSA in patients with suspected OSA.
This retrospective, cross-sectional study included 283 patients who suspected OSA (presence of one or more OSA-related symptom and high-risk category in Berlin questionnaire) and underwent polysomnography and brain magnetic resonance angiography (MRA). The ICAS was defined as ≥50% decrease of luminal diameter in MRA. The severity of OSA was defined by apnea-hypopnea index (AHI).
The mean age was 60.7 ± 13.5 years, and 55.8% (158/283) were male in all included patients. The 53 (18.7%) patients had ICAS and 117 (41.3%) patients had moderate to severe OSA (AHI ≥ 15). Higher AHI was noted in patients with ICAS compared to those without ICAS (31.7 ± 25.8 versus 15.2 ± 17.4, p = 0.001). In multivariable logistic analyses, after adjusting for age, sex, and variables with p < 0.1 in univariable analyses (hypertension, diabetes mellitus, atrial fibrillation, previous stroke history, body mass index, lipid-lowing agents, arousal index, and minimum oxygen saturation), moderate to severe OSA were independently related with the presence of ICAS (odds ratio 4.17, 95% confidence interval 1.40–12.40, p = 0.010).
Our findings suggest that moderate to severe OSA is associated with the presence of ICAS in patients with suspected OSA.
KeywordsIntracranial cerebral atherosclerosis Obstructive sleep apnea Apnea-hypopnea index
Compliance with ethical standards
Tae-Jin Song provided financial support in the form of Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2015R1D1A1A01057934) and grants of the Korean Society of Neurosonology and the Korean Neurological Associaiton. Kang Hyun Choi was supported by the Research Grant 2014 from Ewha Womans University. Hyang Woon Lee provided financial support in the form of Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2014-R1A2A1A11052103) and Ministry of Education the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health and Welfare (HI14C1989).
The sponsor had no role in the design or conduct of this research.
Conflict of interest
The authors declare that they have no conflict of interest.
Our study was approved by the Institutional Review Board of our hospital and observed strictly with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was waived due to the retrospective nature of study.
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