Skip to main content

Stroke and Obstructive Sleep Apnea: A Review

Current Atherosclerosis Reports volume 15, Article number: 334 (2013) Cite this article

Abstract

Obstructive sleep apnea (OSA) has been found to be an independent risk factor for stroke in large epidemiological studies. The mechanisms underlying this relationship have been investigated over the past 2–3 decades, with a particular focus on identifying pathophysiological pathways and risk modification strategies. Despite the advancements made, the specific understanding of the implicated mechanisms is still limited. This brief review focuses on presenting some of the epidemiological evidence of the linkage between OSA and stroke, discussing mechanistic pathways and the potential effect of OSA treatment in modulating the risk for stroke in these patients. Future directions for research in this field are also discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–84.

    Article  PubMed  CAS  Google Scholar 

  2. Sullivan CE, Issa FG. Pathophysiological mechanisms in obstructive sleep apnea. Sleep. 1980;3(3–4):235–46.

    PubMed  CAS  Google Scholar 

  3. Fusetti M, Fioretti AB, Valenti M, Masedu F, Lauriello M, Pagliarella M. Cardiovascular and metabolic comorbidities in patients with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2012;32(5):320–5.

    PubMed  CAS  Google Scholar 

  4. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.

    Article  PubMed  CAS  Google Scholar 

  5. Sacco S, Peverini F, Bastianello S, De Leo G, Marini C, Carolei A. Severe oxygen desaturation in obstructive sleep-apnea syndrome as a possible cause of ischemic stroke. Eur Neurol. 2005;53(2):86–7.

    Article  PubMed  Google Scholar 

  6. •• Loke YK, Brown JW, Kwok CS, Niruban A, Myint PK. Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5(5):720–8. The authors present data from a meta-analysis of nine relevant prospective studies evaluating stroke and cardiovascular disease in sleep apnea. Their analysis demonstrated an overall odds ratio for incident stroke of 2.24 (1.57, 3.19 CI) among patients with sleep apnea. The risk was increased with worse severity of disease, as measured by the AHI.

    Article  PubMed  Google Scholar 

  7. Godoy J, Mellado P, Tapia J, Santin J. Obstructive sleep apnea as an independent stroke risk factor: possible mechanisms. Curr Mol Med. 2009;9(2):203–9.

    Article  PubMed  CAS  Google Scholar 

  8. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897–904.

    Article  PubMed  CAS  Google Scholar 

  9. Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007;132(1):325–37.

    Article  PubMed  Google Scholar 

  10. Hudgel DW. Mechanisms of obstructive sleep apnea. Chest. 1992;101(2):541–9.

    Article  PubMed  CAS  Google Scholar 

  11. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.

    Article  PubMed  CAS  Google Scholar 

  12. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25.

    Article  PubMed  CAS  Google Scholar 

  13. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–36.

    Article  PubMed  CAS  Google Scholar 

  14. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–51.

    Article  PubMed  Google Scholar 

  15. Martinez-Garcia MA, Galiano-Blancart R, Roman-Sanchez P, Soler-Cataluna JJ, Cabero-Salt L, Salcedo-Maiques E. Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest. 2005;128(4):2123–9.

    Article  PubMed  Google Scholar 

  16. Fletcher EC. Cardiovascular effects of continuous positive airway pressure in obstructive sleep apnea. Sleep. 2000;15(23):S154–157.

    Google Scholar 

  17. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–53.

    PubMed  Google Scholar 

  18. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.

    Article  PubMed  CAS  Google Scholar 

  19. Iber C. ea: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007.

  20. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics—2013 update: a report from the american heart association. Circulation. 2012;127(1):143–52.

    Article  Google Scholar 

  21. Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med. 1997;127(8 Pt 1):581–7.

    Article  PubMed  CAS  Google Scholar 

  22. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.

    Article  PubMed  CAS  Google Scholar 

  23. Ferguson KAOT, Lowe AA, Ryan C, Fleetham JA. The Relationship Between Obesity And Craniofacial Structure In Obstructive Sleep Apnea. Chest. 1995;108(102):375–81.

    Article  PubMed  CAS  Google Scholar 

  24. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017–9.

    Article  PubMed  Google Scholar 

  25. • Rice TB, Foster GD, Sanders MH, Unruh M, Reboussin D, Kuna ST, et al. The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus. Sleep. 2012;35(9):1293–8. This article reports data in 305 overweight or obese participants with type 2 diabetes evaluated by full polysomnography to determine the presence and severity of sleep apnea as part of an evaluation of the association of cardiovascular disease and stroke in this population. The study revealed that sleep apnea was associated with an increased odds ratio for stroke of 2.57 (1.03, 6.42 CI) after adjusting for confounding variables.

    PubMed  Google Scholar 

  26. Silverberg DS, Oksenberg A, Iaina A. Sleep-related breathing disorders as a major cause of essential hypertension: fact or fiction? Curr Opin Nephrol Hypertens. 1998;7(4):353–7.

    Article  PubMed  CAS  Google Scholar 

  27. Fletcher EC, DeBehnke RD, Lovoi MS, Gorin AB. Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med. 1985;103(2):190–5.

    Article  PubMed  CAS  Google Scholar 

  28. Kales A, Bixler EO, Cadieux RJ, Schneck DW, Shaw 3rd LC, Locke TW, et al. Sleep apnoea in a hypertensive population. Lancet. 1984;2(8410):1005–8.

    Article  PubMed  CAS  Google Scholar 

  29. Lavie P, Ben-Yosef R, Rubin AE. Prevalence of sleep apnea syndrome among patients with essential hypertension. Am Heart J. 1984;108(2):373–6.

    Article  PubMed  CAS  Google Scholar 

  30. Williams AJ, Houston D, Finberg S, Lam C, Kinney JL, Santiago S. Sleep apnea syndrome and essential hypertension. Am J Cardiol. 1985;55(8):1019–22.

    Article  PubMed  CAS  Google Scholar 

  31. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol. 2008;52(8):686–717.

    Article  PubMed  Google Scholar 

  32. •• Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O'Connor GT, Resnick HE, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010;18(2):269–77. The authors present the results of one of the largest epidemiological studies in sleep apnea, the Sleep Heart Health Study. A total of 5,422 subjects with full overnight polysomnography were prospectively followed for a period of 8.7 years. In men, an increased odds ratio for stroke was seen in association with an AHI above 20 events /h, at 2.86 (1.1, 7.4 CI). An incremental risk for stroke was seen in men for each unit of increase in AHI. In women, stroke risk was elevated in association with an AHI above 25.

    Article  Google Scholar 

  33. Society AT. Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes: American Thoracic Society: official statement adopted March 1994. Am J Respir Crit Care Med. 1994;150:1738–45.

    Article  Google Scholar 

  34. Schulz R, Olschewski H, Grimminger F, Seeger W. Prevalence of stroke and transitory ischemic attacks in obstructive sleep apnea: a retrospective analysis of 187 consecutive patients. Pneumologie. 2000;54(12):575–9.

    Article  PubMed  CAS  Google Scholar 

  35. Nachtmann A, Stang A, Wang YM, Wondzinski E, Thilmann AF. Association of obstructive sleep apnea and stenotic artery disease in ischemic stroke patients. Atherosclerosis. 2003;169(2):301–7.

    Article  PubMed  CAS  Google Scholar 

  36. Valham F, Mooe T, Rabben T, Stenlund H, Wiklund U, Franklin KA. Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up. Circulation. 2008;118(9):955–60.

    Article  PubMed  Google Scholar 

  37. Romaniak A. Stepien A: [Sleep disorders as a risk factors for stroke]. Neurol Neurochir Pol. 2001;35(5):821–7.

    PubMed  CAS  Google Scholar 

  38. Ahn SH, Kim JH, Kim DU, Choo IS, Lee HJ, Kim HW. Interaction between Sleep-Disordered Breathing and Acute Ischemic Stroke. J Clin Neurol. 2013;9(1):9–13.

    Article  PubMed  Google Scholar 

  39. Medical Expenditure Panel Survey (MEPS) of the Agency for Healthcare Research and Quality (AHRQ). 2008.

  40. Levy P, Tamisier R, Launois S. Pepin JL: [Surviving sleep: when the heart and brain are damaged by apnea]. Bull Acad Natl Med. 2011;195(7):1611–28.

    PubMed  Google Scholar 

  41. Mohsenin V. Sleep-related breathing disorders and risk of stroke. Stroke. 2001;32(6):1271–8.

    Article  PubMed  CAS  Google Scholar 

  42. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290(14):1906–14.

    Article  PubMed  CAS  Google Scholar 

  43. Netzer N, Werner P, Jochums I, Lehmann M, Strohl KP. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke. 1998;29(1):87–93.

    Article  PubMed  CAS  Google Scholar 

  44. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.

    Article  PubMed  CAS  Google Scholar 

  45. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320(7233):479–82.

    Article  PubMed  CAS  Google Scholar 

  46. Davies CW, Crosby JH, Mullins RL, Barbour C, Davies RJ, Stradling JR. Case-control study of 24 hour ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects. Thorax. 2000;55(9):736–40.

    Article  PubMed  CAS  Google Scholar 

  47. Tolle FA, Judy WV, Yu PL, Markand ON. Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol. 1983;55(6):1718–24.

    PubMed  CAS  Google Scholar 

  48. Yumino D, Kasai T, Kimmerly D, Amirthalingam V, Floras JS, Bradley TD. Differing effects of obstructive and central sleep apneas on stroke volume in patients with heart failure. Am J Respir Crit Care Med. 2013;187(4):433–8.

    Article  PubMed  Google Scholar 

  49. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–e209.

    Article  PubMed  Google Scholar 

  50. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8.

    Article  PubMed  CAS  Google Scholar 

  51. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760–4.

    Article  PubMed  CAS  Google Scholar 

  52. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke. 2005;36(6):1115–9.

    Article  PubMed  Google Scholar 

  53. Rossi VA, Stradling JR, Kohler M. Effects of obstructive sleep apnoea on heart rhythm. Eur Respir J. 2012;2012:20.

    Google Scholar 

  54. Ferro JM, Massaro AR, Mas JL. Aetiological diagnosis of ischaemic stroke in young adults. Lancet Neurol. 2010;9(11):1085–96.

    Article  PubMed  Google Scholar 

  55. • Ciccone A, Proserpio P, Roccatagliata DV, Nichelatti M, Gigli GL, Parati G, et al. Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: a cross-sectional study. Thorax. 2013;68(1):97–104. This article evaluates the potential for paradoxical embolism as an etiology for stroke in OSA. The authors present a prospective evaluation of 335 patients with acute stroke or TIA, in which 21 % had evidence of prolonged apneic episodes and right-to-left shunt. The adjusted odds ratio for stroke or TIA upon waking was elevated in this subset at 1.91 (1.08, 3.38 CI).

    Article  PubMed  Google Scholar 

  56. Beelke M, Angeli S, Del Sette M, De Carli F, Canovaro P, Nobili L, et al. Obstructive sleep apnea can be provocative for right-to-left shunting through a patent foramen ovale. Sleep. 2002;25(8):856–62.

    PubMed  Google Scholar 

  57. Lau EM, Yee BJ, Grunstein RR, Celermajer DS. Patent foramen ovale and obstructive sleep apnea: a new association? Sleep Med Rev. 2010;14(6):391–5.

    Article  PubMed  Google Scholar 

  58. Shiina K, Tomiyama H, Takata Y, Usui Y, Asano K, Hirayama Y, et al. Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study. Hypertens Res. 2006;29(6):433–41.

    Article  PubMed  Google Scholar 

  59. Lavie L. Obstructive sleep apnoea syndrome—an oxidative stress disorder. Sleep Med Rev. 2003;7(1):35–51.

    Article  PubMed  Google Scholar 

  60. Ip MS, Lam B, Chan LY, Zheng L, Tsang KW, Fung PC, et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med. 2000;162(6):2166–71.

    Article  PubMed  CAS  Google Scholar 

  61. Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM, Lorenzi-Filho G. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172(5):613–8.

    Article  PubMed  Google Scholar 

  62. Von Kanel R, Loredo JS, Ancoli-Israel S, Mills PJ, Natarajan L, Dimsdale JE. Association between polysomnographic measures of disrupted sleep and prothrombotic factors. Chest. 2007;131(3):733–9.

    Article  Google Scholar 

  63. Dumitrascu R, Tiede H, Rosengarten B. Schulz R: [Obstructive sleep apnea and stroke]. Pneumologie. 2012;66(8):476–9.

    Article  PubMed  CAS  Google Scholar 

  64. Urbano F, Roux F, Schindler J, Mohsenin V. Impaired cerebral autoregulation in obstructive sleep apnea. J Appl Physiol. 2008;105(6):1852–7.

    Article  PubMed  Google Scholar 

  65. Nasr N, Traon AP, Czosnyka M, Tiberge M, Schmidt E, Larrue V. Cerebral autoregulation in patients with obstructive sleep apnea syndrome during wakefulness. Eur J Neurol. 2009;16(3):386–91.

    Article  PubMed  CAS  Google Scholar 

  66. Fletcher EC. Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea. Sleep. 2003;26(1):15–9.

    PubMed  Google Scholar 

  67. Fletcher EC. Cardiovascular disease associated with obstructive sleep apnea. Monaldi Arch Chest Dis. 2003;59(3):254–61.

    PubMed  CAS  Google Scholar 

  68. Ward S, Ryan S, Mc Nicholas WT, Heneghan C. Comparison of baroreflex sensitivity measures for assessing subjects with obstructive sleep apnea. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3572–5.

    PubMed  Google Scholar 

  69. Kasasbeh E, Chi DS, Krishnaswamy G. Inflammatory aspects of sleep apnea and their cardiovascular consequences. South Med J. 2006;99(1):58–67.

    Article  PubMed  CAS  Google Scholar 

  70. Lavie L. Sleep-disordered breathing and cerebrovascular disease: a mechanistic approach. Neurol Clin. 2005;23(4):1059–75.

    Article  PubMed  Google Scholar 

  71. Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation. 2005;112(17):2660–7.

    Article  PubMed  CAS  Google Scholar 

  72. Lavie L, Dyugovskaya L, Lavie P. Sleep-apnea-related intermittent hypoxia and atherogenesis: adhesion molecules and monocytes/endothelial cells interactions. Atherosclerosis. 2005;183(1):183–4. Epub 2005 Aug 1.; 2005.

    Article  PubMed  CAS  Google Scholar 

  73. Spiegel K, Knutson K, Leproult R, Tasali E, Van Cauter E. Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol. 2005;99(5):2008–19.

    Article  PubMed  CAS  Google Scholar 

  74. Makino S, Handa H, Suzukawa K, Fujiwara M, Nakamura M, Muraoka S, et al. Obstructive sleep apnoea syndrome, plasma adiponectin levels, and insulin resistance. Clin Endocrinol. 2006;64(1):12–9.

    Article  CAS  Google Scholar 

  75. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165(5):670–6.

    Article  PubMed  Google Scholar 

  76. Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99(5):1998–2007.

    Article  PubMed  CAS  Google Scholar 

  77. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521–30.

    Article  PubMed  Google Scholar 

  78. Masserini B, Morpurgo PS, Donadio F, Baldessari C, Bossi R, Beck-Peccoz P, et al. Reduced levels of adiponectin in sleep apnea syndrome. J Endocrinol Invest. 2006;29(8):700–5.

    PubMed  CAS  Google Scholar 

  79. Ursavas A, Ilcol YO, Nalci N, Karadag M, Ege E. Ghrelin, leptin, adiponectin, and resistin levels in sleep apnea syndrome: Role of obesity. Ann Thorac Med. 2010;5(3):161–5.

    Article  PubMed  CAS  Google Scholar 

  80. Shepard Jr JW. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med. 1992;13(3):437–58.

    PubMed  Google Scholar 

  81. Reilly DF, Westgate EJ, FitzGerald GA. Peripheral circadian clocks in the vasculature. Arterioscler Thromb Vasc Biol. 2007;27(8):1694–705.

    Article  PubMed  CAS  Google Scholar 

  82. Tofler GH, Brezinski D, Schafer AI, Czeisler CA, Rutherford JD, Willich SN, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med. 1987;316(24):1514–8.

    Article  PubMed  CAS  Google Scholar 

  83. Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206–14.

    Article  PubMed  CAS  Google Scholar 

  84. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52(5):490–4.

    Article  PubMed  CAS  Google Scholar 

  85. Shepard Jr JW, Garrison MW, Grither DA, Dolan GF. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest. 1985;88(3):335–40.

    Article  PubMed  Google Scholar 

  86. Zwillich C, Devlin T, White D, Douglas N, Weil J, Martin R. Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest. 1982;69(6):1286–92.

    Article  PubMed  CAS  Google Scholar 

  87. Koehler U, Fus E, Grimm W, Pankow W, Schafer H, Stammnitz A, et al. Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment. Eur Respir J. 1998;11(2):434–9.

    Article  PubMed  CAS  Google Scholar 

  88. Somers VK. Sleep—a new cardiovascular frontier. N Engl J Med. 2005;353(19):2070–3.

    Article  PubMed  CAS  Google Scholar 

  89. Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003;107(8):1129–34.

    Article  PubMed  CAS  Google Scholar 

  90. Harsch IA, Schahin SP, Bruckner K, Radespiel-Troger M, Fuchs FS, Hahn EG, et al. The effect of continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnoea syndrome and type 2 diabetes. Respiration. 2004;71(3):252–9.

    Article  PubMed  Google Scholar 

  91. Harbison J, O'Reilly P, McNicholas WT. Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest. 2000;118(3):591–5.

    Article  PubMed  CAS  Google Scholar 

  92. Pressman MR, Schetman WR, Figueroa WG, Van Uitert B, Caplan HJ, Peterson DD. Transient ischemic attacks and minor stroke during sleep. Relationship to obstructive sleep apnea syndrome. Stroke. 1995;26(12):2361–5.

    Article  PubMed  CAS  Google Scholar 

  93. Tikare SK, Chaudhary BA, Bandisode MS. Hypertension and stroke in a young man with obstructive sleep apnea syndrome. Postgrad Med. 1985;78(7):59–60.

    PubMed  CAS  Google Scholar 

  94. Disler P, Hansford A, Skelton J, Wright P, Kerr J, O'Reilly J, et al. Diagnosis and treatment of obstructive sleep apnea in a stroke rehabilitation unit: a feasibility study. Am J Phys Med Rehabil. 2002;81(8):622–5.

    Article  PubMed  Google Scholar 

  95. Parra-Ordaz O. The importance of treatment for breathing disorders during sleep in stroke patients. Rev Neurol. 2005;1(41):S35–37.

    Google Scholar 

  96. Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, Soriano Y, Roman-Sanchez P, Illa FB, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med. 2009;180(1):36–41.

    Article  PubMed  Google Scholar 

  97. Ryan CM, Bayley M, Green R, Murray BJ, Bradley TD. Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea. Stroke. 2011;42(4):1062–7.

    Article  PubMed  Google Scholar 

  98. Tomfohr LM, Hemmen T, Natarajan L, Ancoli-Israel S, Loredo JS, Heaton RK, et al. Continuous positive airway pressure for treatment of obstructive sleep apnea in stroke survivors: what do we really know? Stroke. 2012;43(11):3118–23.

    Article  PubMed  Google Scholar 

  99. Padma A, Ramakrishnan N, Narayanan V. Management of obstructive sleep apnea: A dental perspective. Indian J Dent Res. 2007;18(4):201–9.

    Article  PubMed  Google Scholar 

  100. Li KK. Sleep apnea surgery: putting it all together. Oral Maxillofac Surg Clin North Am. 2009;21(4):421–3.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

Daniel A. Barone declares that he has no conflicts of interest.

Ana C. Krieger declares that she has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Neurology, Weill Cornell Medical College Center for Sleep Medicine, Cornell University, 425 East 61st Street – 5th floor, New York, NY, 10065, USA

    Daniel A. Barone

  2. Departments of Medicine, Neurology and Genetic Medicine, Weill Cornell Medical College Center for Sleep Medicine, Cornell University, 425 East 61st Street – 5th floor, New York, NY, 10065, USA

    Ana C. Krieger

Authors
  1. Daniel A. Barone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana C. Krieger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ana C. Krieger.

Additional information

This article is part of the Topical Collection on Cardiovascular Disease and Stroke

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Barone, D.A., Krieger, A.C. Stroke and Obstructive Sleep Apnea: A Review. Curr Atheroscler Rep 15, 334 (2013). https://doi.org/10.1007/s11883-013-0334-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-013-0334-8

Keywords

  • Stroke
  • Sleep apnea
  • Obstructive sleep apnea
  • Thrombosis
  • Cardiovascular disease
  • Cerebrovascular disease