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

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Abstract

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Jessica Kepplinger, Kristian Barlinn, Volker Puetz, Lars-Peder Pallesen, Wiebke Schrempf, Imanuel Dzialowski, Heinz Reichmann & Ulf Bodechtel

  2. Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL, USA

    Kristian Barlinn, Karen C. Albright & Andrei V. Alexandrov

  3. Department of Epidemiology, School of Public Health, University of Alabama Hospital, Birmingham, AL, USA

    Amelia K. Boehme & Karen C. Albright

  4. Division of Neuroradiology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany

    Johannes Gerber & Ruediger von Kummer

  5. Elblandklinikum Meissen, Department of Neurology, Academic Teaching Hospital, University of Technology Dresden, Meissen, Dresden, Germany

    Imanuel Dzialowski

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  1. Jessica Kepplinger
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  2. Kristian Barlinn
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Corresponding author

Correspondence to Jessica Kepplinger.

Additional information

J. Kepplinger and K. Barlinn contributed equally to this work.

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Kepplinger, J., Barlinn, K., Boehme, A.K. et al. Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia. J Neurol 261, 343–349 (2014). https://doi.org/10.1007/s00415-013-7200-z

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  • DOI: https://doi.org/10.1007/s00415-013-7200-z

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