Advertisement

Journal of Neurology

, Volume 266, Issue 6, pp 1351–1357 | Cite as

Increased risk for subarachnoid hemorrhage in patients with sleep apnea

  • Sebastian ZarembaEmail author
  • Luca Albus
  • Patrick Schuss
  • Hartmut Vatter
  • Thomas Klockgether
  • Erdem Güresir
Original Communication

Abstract

Objectives

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.

Methods

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.

Results

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).

Interpretation

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.

Keywords

Subarachnoid hemorrhage Sleep apnea Intracranial aneurysm Sleep disorders Intracranial bleeding 

Notes

Author contributions

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.

References

  1. 1.
    Pobereskin LH (2001) Incidence and outcome of subarachnoid haemorrhage: a retrospective population based study. J Neurol Neurosurg Psychiatry 70:340–343CrossRefGoogle Scholar
  2. 2.
    Shea AM, Reed SD, Curtis LH et al (2007) Characteristics of nontraumatic subarachnoid hemorrhage in the United States in 2003. Neurosurgery 61:1131–1137 (discussion 1137–1138) CrossRefGoogle Scholar
  3. 3.
    Walendy V, Strauss C, Rachinger J et al (2014) Treatment of aneurysmal subarachnoid haemorrhage in Germany: a nationwide analysis of the years 2005–2009. Neuroepidemiology 42:90–97CrossRefGoogle Scholar
  4. 4.
    Schuiling WJ, Rinkel GJ, Walchenbach R et al (2005) Disorders of sleep and wake in patients after subarachnoid hemorrhage. Stroke 36:578–582CrossRefGoogle Scholar
  5. 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. 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. 7.
    AASM (2005) The international classification of sleep disorders: diagnostic and coding manual, 2nd edn. Westchester, ILGoogle Scholar
  8. 8.
    Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20CrossRefGoogle Scholar
  9. 9.
    Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9CrossRefGoogle Scholar
  10. 10.
    Morrone E, Pistarini C, Cazzulani B et al (2016) Sleep apnea after posterior cerebral artery aneurysm rupture and elevated intracranial pressure: a Chiari-like syndrome. Sleep Med 21:42–44CrossRefGoogle Scholar
  11. 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
  12. 12.
    Burns JD, Huston J 3rd, Layton KF et al (2009) Intracranial aneurysm enlargement on serial magnetic resonance angiography: frequency and risk factors. Stroke 40:406–411CrossRefGoogle Scholar
  13. 13.
    Barone-Rochette G, Thony F, Boggetto-Graham L et al (2015) Aortic expansion assessed by imaging follow-up after acute aortic syndrome: effect of sleep apnea. Am J Respir Crit Care Med 192:111–114CrossRefGoogle Scholar
  14. 14.
    Mason RH, Ruegg G, Perkins J et al (2011) Obstructive sleep apnea in patients with abdominal aortic aneurysms: highly prevalent and associated with aneurysm expansion. Am J Respir Crit Care Med 183:668–674CrossRefGoogle Scholar
  15. 15.
    Tachikawa R, Hamada S, Azuma M et al (2014) Impact of obstructive sleep apnea on abdominal aortic diameters. Am J Cardiol 114:618–623CrossRefGoogle Scholar
  16. 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
  17. 17.
    Brown RD Jr, Broderick JP (2014) Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 13:393–404CrossRefGoogle Scholar
  18. 18.
    Brewster DC, Cronenwett JL, Hallett JW Jr et al (2003) Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 37:1106–1117CrossRefGoogle Scholar
  19. 19.
    Guresir E, Vatter H, Schuss P et al (2013) Natural history of small unruptured anterior circulation aneurysms: a prospective cohort study. Stroke 44:3027–3031CrossRefGoogle Scholar
  20. 20.
    Francis SE, Tu J, Qian Y et al (2013) A combination of genetic, molecular and haemodynamic risk factors contributes to the formation, enlargement and rupture of brain aneurysms. J Clin Neurosci 20:912–918CrossRefGoogle Scholar
  21. 21.
    Lindbohm JV, Kaprio J, Jousilahti P (2016) et.al. Sex, Smoking, and Risk for Subarachnoid Hemorrhage. Stroke 47:1975–1981CrossRefGoogle Scholar
  22. 22.
    Fietze I, Laharnar N, Obst A et al (2018) Prevalence and association analysis of obstructive sleep apnea with gender and age differences—results of SHIP-trend. J Sleep Res 1:e12770 (Epub ahead of print) CrossRefGoogle Scholar
  23. 23.
    Kario K (2009) Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure. Hypertens Res 32:428–432CrossRefGoogle Scholar
  24. 24.
    Gaisl T, Bratton DJ, Kohler M (2015) The impact of obstructive sleep apnoea on the aorta. Eur Respir J 46:532–544CrossRefGoogle Scholar
  25. 25.
    Zaremba S, Güresir E (2019) Is there a causal relationship between obstructive sleep apnea and the pathophysiology of intracranial aneurysm? Somnology.  https://doi.org/10.1007/s11818-019-0191-y (epub ahead of print) Google Scholar
  26. 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
  27. 27.
    Jelic S, Le Jemtel TH (2008) Inflammation, oxidative stress, and the vascular endothelium in obstructive sleep apnea. Trends Cardiovasc Med 18:253–260CrossRefGoogle Scholar
  28. 28.
    Eagleton MJ (2012) Inflammation in abdominal aortic aneurysms: cellular infiltrate and cytokine profiles. Vascular 20:278–283CrossRefGoogle Scholar
  29. 29.
    Mokhlesi B, Hovda MD, Vekhter B et al (2013) Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest 144:903–914CrossRefGoogle Scholar
  30. 30.
    Kapur V, Strohl KP, Redline S et al (2002) Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath 6:49–54CrossRefGoogle Scholar
  31. 31.
    Senaratna CV, Perret JL, Lodge CJ et al (2017) Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev 34:70–81CrossRefGoogle Scholar
  32. 32.
    Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet 383:736–747CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurology, University Hospital BonnRheinische Friedrich-Wilhelms-UniversityBonnGermany
  2. 2.Department of NeurosurgeryRheinische Friedrich-Wilhelms-UniversityBonnGermany

Personalised recommendations