DOI: 10.1097/01.sa.0000204702.94939.b8
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Issn Print: 0039-6206
Publication Date: 2006/04/01
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Excerpt
H. Klar Yaggi,*†‡ John Concato,‡§ Walter N. Kernan,§ Judith H. Lichtman,∥ Lawrence M. Brass,∥¶# and Vahid Mohsenin*
(N Engl J Med, 353:2034-2041, 2005)
*Section of Pulmonary and Critical Care Medicine, Yale Center for Sleep Medicine; †Section of Pulmonary and Critical Care Medicine, the ‡Clinical Epidemiology Research Center, §Section of General Medicine, the ∥Departments of Epidemiology and Public Health and ¶Neurology, Yale University School of Medicine, New Haven, CT and the #Section of Neurology, Veterans Affairs Connecticut Healthcare System, West Haven, CT.
Although previous studies have suggested that obstructive sleep apnea (OSA) may be a major risk factor for stroke, it had not been established whether the OSA syndrome is independently related to the risk of stroke or death from any cause after adjustment for other risk factors, including hypertension. Therefore, in this observational cohort study, consecutive patients underwent polysomnography, and subsequent strokes and deaths were verified. The diagnosis of OSA syndrome was based on an apnea-hypopnea index of 5 or higher (≥5 events per hour). Patients with an apnea-hypopnea index of less than 5 served as the comparison group. Proportional hazards analysis was used to determine the independent effect of the OSA syndrome on composite outcome of stroke or death from any cause.
Among 1022 enrolled patients referred for sleep-disordered breathing, 697 (68%) had OSA syndrome. At baseline, the mean apnea-hypopnea index of patients with the syndrome was 35, compared with a mean apnea-hypopnea index of 2 in the comparison group. In an unadjusted analysis, OSA was associated with stroke or death from any cause (hazard ratio, 2.24; 95% confidence interval, 1.30-3.86; P = 0.004). After adjustment for age, sex, race, smoking status, alcohol consumption status, body mass index, and the presence or absence of diabetes mellitus, hyperlipidemia, atrial fibrillation, and hypertension, the OSA syndrome retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95% confidence interval, 1.12-3.48; P = 0.01). In a trend analysis, increased severity of sleep apnea at baseline was associated with an increased risk of the development of the composite end point (P = 0.005). The investigators concluded that OSA syndrome increases the risk of stroke or death from any cause, and the risk is independent of other risk factors, including hypertension.
