Elsevier

Sleep Medicine

Volume 30, February 2017, Pages 251-254
Sleep Medicine

Brief Communication
Atrial fibrillation is a major cause of stroke in apneic patients: a prospective study

https://doi.org/10.1016/j.sleep.2015.07.031Get rights and content

Highlights

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    We investigated the association between sleep-disordered breathing (SDB) and stroke mechanism.

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    We compared ASCO and TOAST classifications to detect stroke mechanism.

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    SDB was detected using polygraphic recording during hospitalization.

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    We observed a higher rate of stroke related to atrial fibrillation in SDB patients.

Abstract

Objectives

Large prospective studies have established that sleep-disordered breathing (SDB) is associated with an increased incidence of cardiovascular and cerebrovascular diseases. Heterogeneous results have been published about SDB and ischaemic stroke mechanism. The aim of this study was to evaluate the relationship between poststroke apneic syndrome and stroke aetiologies according to the ASCO classification.

Methods

A total of 134 patients with acute ischaemic cerebrovascular events were prospectively included. Patients with severe or infratentorial infarctions were excluded. Stroke risk factors and clinical characteristics were recorded in all patients. An overnight polygraphy was recorded (Embletta PDS). Apneic patients were defined if the polygraphy reported an apnea–hypopnea index ≥15. A standardized diagnosis workup, including serum biological investigation, evaluation of extra and intracranial arteries and heart morphology and function, was performed. Stroke mechanism was defined using ASCO and TOAST classifications.

Results

A proportion of 42% (56 of 134) of the patients were diagnosed as having sleep apneas. Apneic patients were older (p < 0.001), had higher BMI (p = 0.02), and more were hypertensive (p < 0.001). Using ASCO classification, a major cardioembolic source of stroke, mainly atrial fibrillation, was more frequently observed in apneic patients (41.1% vs. 20.5%, p < 0.05), while no difference was observed when considering atherosclerosis or small-vessel disease mechanisms. Univariate analysis showed that cardioembolic stroke depends on sex, age, left atrial size and OSA; however, age remained the only significant factor in multivariate analysis.

Conclusion

This study confirms the high prevalence of sleep apneas in stroke-affected patients and identifies atrial fibrillation as a major source of stroke in this population. The strong correlation between age and SDB seems to drive the increased frequency of stroke related to atrial fibrillation in this population.

Section snippets

Study population and clinical variables

All patients included in this prospective study were initially admitted to the stroke unit of our university hospital for a suspected cerebral infarct or transient ischaemic attacks. Primary inclusion criteria were as follows: men and women, aged 45–90 years, with a clinical diagnosis of minor to moderate supratentorial cerebral infarct (National Institutes of Health Stroke Scale NIHSS < 14) evolving for <3 days. Noninclusion criteria include previous clinical history of stroke, coma and

Results

A total of 134 patients with first acute ischaemic stroke (54 women and 80 men) were included in the study. In the study cohort, the mean age was 66.8 ± 11.4 years. The mean NIHSS score at hospital admission was 6 ± 5.7. A proportion of 42% (56 patients) had an obstructive AHI > 15 (33.7 ± 15.1) with a mean oxygen desaturation index of 30.5 ± 15.2 (Table 1). SDB patients had a significantly higher biological inflammatory profile (Table 1).

Using TOAST classification, we observed a higher

Discussion

This study confirms the high prevalence of SDB in patients with ischaemic stroke and highlights the role of AF as a major stroke mechanism in these patients. Conflicting data have been published about the frequency of cardioembolic stroke mechanism in patients with SDB; however, our results are in congruence with the recent studies that have reported an association between cardioembolic source [10], more specifically AF [11] and SDB in stroke patients. The use of ASCO classification allowed to

contributions

Mathilde Poli collected, analyzed and interpreted all data; made the literature search; and drafted the manuscript.

Pierre Philip conceptualized and designed the study, and revised the manuscript.

Jacques Taillard collected and interpreted study data, and revised the manuscript.

Sabrina Debruxelles collected study data.

Pauline Renou collected study data.

François Rouanet collected study data.

Jean-Marc Orgogozo conceptualized and designed the study, and revised the manuscript.

Igor Sibon

of interest

None.

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.07.031.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

Acknowledgement

This study was supported by Bordeaux University Hospital (CHUBX 2006/10).

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