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Published ahead of print on September 1, 2005, doi:10.1164/rccm.200505-702OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 11, December 2005, 1447-1451

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Submitted on May 4, 2005
Accepted on September 1, 2005

Association of Sleep-Disordered Breathing and the Occurrence of Stroke

Michael Arzt1, Terry Young2, Laurel Finn2, James B Skatrud3, and T. Douglas Bradley1*

1 Sleep Research Laboratory of the Toronto Rehabilitation Institute, the Center for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada, 2 Department of Population Health Sciences, University of Wisconsin School of Medicine, Madison, Wisconsin, USA, 3 Department of Medicine, University of Wisconsin School of Medicine, Madison, Wisconsin, USA

* To whom correspondence should be addressed. E-mail: douglas.bradley{at}utoronto.ca.

Rationale: Sleep-disordered breathing has been linked to stroke in previous studies. However, these studies either used surrogate markers of sleep-disordered breathing, or could not address the temporal relationship between sleep-disordered breathing and stroke due to cross-sectional design. Objectives: To determine whether sleep-disordered breathing increases the risk for stroke. Methods: We performed cross-sectional and longitudinal analyses on 1,475 and 1,189 subjects, respectively, from the general population. Sleep-disordered breathing was defined by the apnea-hypopnea index (frequency of apneas and hypopneas per hour of sleep) obtained by attended polysomnography. The protocol, including polysomnography, risk factors for stroke, and a history of physician-diagnosed stroke was repeated at 4-year intervals. Measurements and Main Results: In the cross-sectional analysis, subjects with an apnea-hypopnea index ≥20 had increased odds for stroke compared to those without sleep-disordered breathing (apnea-hypopnea index <5; odds ratio, 4.33; 95 percent confidence interval [CI], 1.32-14.24; p=0.02), after adjustment for known confounding factors. In the prospective analysis, sleep-disordered breathing with an apnea-hypopnea index ≥20 was associated with an increased risk of suffering a first-ever stroke over the next 4 years (unadjusted odds ratio, 4.31, 95 percent CI, 1.31-14.15, p=0.02) after adjustment for age and sex, with p=0.12 after further adjustment for body-mass index. Conclusions: These data demonstrate a strong association between moderate to severe sleep-disordered breathing and prevalent stroke, independent of confounding factors. They also provide the first prospective evidence that sleep-disordered breathing precedes stroke and may contribute to the development of stroke.
Key words: Sleep apnea, sleep-disordered breathing, risk factors, stroke, cerebrovascular disease




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