Increased risk for subarachnoid hemorrhage in patients with sleep apnea
Recent retrospective studies found sleep disorders, including obstructive sleep apnea and its symptoms to occur more often in patients following aneurysmal subarachnoid hemorrhage, but studies investigating the incidence of subarachnoid hemorrhage in patients with diagnosed obstructive sleep apnea [OSA] compared to other sleep disorders are missing.
To test our hypothesis that aneurysmal subarachnoid hemorrhage occurs more often in patients with OSA compared to other sleep disorders, we analyzed clinical data of 5514 patients with OSA, 4150 with other sleep disorders, and 964 patients with aneurysmal subarachnoid hemorrhage diagnosed between 01/01/2007 and 12/31/2016. As a secondary outcome, location and size of the ruptured aneurysm were calculated based on computer tomography. Incidence of SAH, as well as size and location were compared between patients with OSA and patients with other sleep disorders, diagnosed by polysomnography.
Aneurysmal subarachnoid hemorrhage occurred in 8.3 per 100,000 patients with sleep disorders per year. Its incidence was significantly higher in patients with obstructive sleep apnea (14.5 per 100,000 patients per year), compared to other sleep disorders (2.4 per 100,000 patients per year; RR = 6.8; p = 0.04). The size of the ruptured aneurysm was larger in patients with OSA (19.0 ± 5.7 mm vs. 8.5 ± 0.5 mm; p = 0.004).
Aneurysmal subarachnoid hemorrhage occurs more often in patients with diagnosed OSA compared to patients with other sleep disorders, possibly due to increased aneurysm enlargement. Obstructive sleep apnea might be a yet unrecognized risk factor for aneurysmal subarachnoid hemorrhage, and sleep apnea screening should be considered in patients with intracranial aneurysm.
KeywordsSubarachnoid hemorrhage Sleep apnea Intracranial aneurysm Sleep disorders Intracranial bleeding
SZ designed the study protocol, performed data acquisition, analyzed the data and wrote the first draft of the manuscript. LA helped in acquisition and analysis of the data and helped to improve the quality of the manuscript. PS contributed to the preparation of the final manuscript. HV contributed to the preparation of the final manuscript. TK contributed to the preparation of the final manuscript. EG designed the study protocol, helped in the analysis of the study data and contributed to the preparation of the final manuscript.
Compliance with ethical standards
Conflicts of interest
SZ does not have any conflicts of interest. LA, PS, HV and TK do not have any conflicts of interest. EG has no conflicts of interest.
- 5.Alaqeel AM, Almasri SH, Alotaibi NM et al (2013) Prevalence of symptoms and risk of sleep apnea in patients with ruptured cerebral aneurysm. Neurosciences (Riyadh) 18:248–251Google Scholar
- 6.Bir SC, Nanda A, Cuellar H et al. Coexistence of obstructive sleep apnea worsens the overall outcome of intracranial aneurysm: a pioneer study. J Neurosurg 2017:1–12Google Scholar
- 7.AASM (2005) The international classification of sleep disorders: diagnostic and coding manual, 2nd edn. Westchester, ILGoogle Scholar
- 11.Chernyshev OY, Bir SC, Maiti TK et al (2017) Changing paradigm in the management of elderly patients with intracranial aneurysms: an institutional review. J Clin NeurosciGoogle Scholar
- 16.Shojima M, Morita A, Nakatomi H et al (2017) Size is the most important predictor of aneurysm rupture among multiple cerebral aneurysms: post hoc subgroup analysis of unruptured cerebral aneurysm study Japan. NeurosurgeryGoogle Scholar
- 26.Nadeem R, Molnar J, Madbouly EM et al (2013) Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med 9:1003–1012Google Scholar