Sex Differences in 90-Day Functional Outcomes for Acute Ischemic Stroke Patients With Obstructive Sleep Apnea.
ais (acute ischemic stroke)
atherosclerosis (as)
atrial fibrillation
brain hypoxia
hypertension
modified rankin scale (mrs)
obstructive sleep apnea (osa)
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
accepted:
29
05
2023
medline:
30
6
2023
pubmed:
30
6
2023
entrez:
30
6
2023
Statut:
epublish
Résumé
Background Obstructive sleep apnea (OSA) is characterized by repeated episodes of either full or partial obstruction of the upper airway. OSA is an independent risk factor for acute ischemic stroke (AIS) and a contributor to other key risk factors. OSA may damage endothelial and brain tissues and worsen outcomes following AIS. We aimed to evaluate the impact of sex differences on 90-day functional outcomes following AIS in an OSA population, as measured by the modified Rankin Scale (mRS) score. Methodology We performed a retrospective study of patients with OSA and AIS from the Houston Methodist Hospital Outcomes-Based Prospective Endpoints in Stroke (HOPES) Registry from 2016 to 2022. Patients with charts that noted a diagnosis of OSA before AIS or within the 90 days following AIS were included. A multivariable logistic regression model was constructed adjusting for demographics, first admit National Institutes of Health Stroke Scale (NIHSS), and comorbidities on the binary outcome. The odds ratios (ORs) and 95% confidence intervals (CIs) were reported, providing likelihood estimates of a shift to higher mRS for a given comparison between females (reference category) and males. Statistical significance was defined as two-tailed p-values <0.05 for all tests. Results From the HOPES registry, 291 females and 449 males were found to have OSA. Males had a higher proportion of comorbid conditions such as atrial fibrillation (15% vs. 9%, p = 0.014) and intracranial hemorrhage compared to females (6% vs. 2%, p = 0.020). The multivariate logistic regression model showed that males were at two times higher risk for developing poor functional outcomes at 90 days (OR = 2.35, 95% CI = 1.06-5.19), p < 0.001). Conclusions Males were found to have two times higher risk for developing poor functional outcomes at 90 days. This may be due to more severe oxygen desaturation, increased susceptibility to oxidative stress, and greater frequency of full airway obstruction in males. Greater emphasis on early diagnosis and treatment of OSA may be necessary to reduce the disproportionate incidence of poor functional outcomes, particularly among apneic male stroke survivors.
Identifiants
pubmed: 37388591
doi: 10.7759/cureus.39652
pmc: PMC10306317
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e39652Informations de copyright
Copyright © 2023, Devenish et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Stroke. 2011 Apr;42(4):1062-7
pubmed: 21372306
Sleep. 2005 Mar;28(3):309-14
pubmed: 16173651
JAMA Cardiol. 2018 Jun 1;3(6):532-540
pubmed: 29541763
Eur Respir J. 2005 Jan;25(1):69-74
pubmed: 15640325
Front Neurol. 2021 Nov 16;12:719311
pubmed: 34867710
J Clin Invest. 2020 Oct 1;130(10):5042-5051
pubmed: 32730232
J Clin Sleep Med. 2016 Apr 15;12(4):533-41
pubmed: 26888587
Stroke. 2007 Jul;38(7):2142-9
pubmed: 17525399
Int J Hypertens. 2017;2017:1848375
pubmed: 29147581
Sleep. 2005 Apr;28(4):449-56
pubmed: 16171289
Neurobiol Sleep Circadian Rhythms. 2016 Nov 29;2:94-105
pubmed: 31236498
J Physiol. 2004 Aug 1;558(Pt 3):993-1004
pubmed: 15218069
Circulation. 2008 Apr 29;117(17):2270-8
pubmed: 18413499
Respir Med. 2009 Jan;103(1):59-66
pubmed: 18804356
Sleep Med. 2009 Dec;10(10):1075-84
pubmed: 19403333
Eur Respir J. 2006 Mar;27(3):564-70
pubmed: 16507857
Eur Respir J. 2001 Oct;18(4):630-4
pubmed: 11716166
Front Neurol. 2017 Dec 11;8:668
pubmed: 29312113
Biochemistry (Mosc). 2016 Nov;81(11):1358-1370
pubmed: 27914461
Circulation. 2004 Jul 27;110(4):364-7
pubmed: 15249509
Proc Am Thorac Soc. 2008 Feb 15;5(2):185-92
pubmed: 18250211
Am J Respir Crit Care Med. 2009 Jul 1;180(1):36-41
pubmed: 19406983
Hypertens Res. 2019 Jan;42(1):27-28
pubmed: 30393380
Eur Respir J. 2012 Apr;39(4):906-12
pubmed: 21965227
Braz J Med Biol Res. 2002 Sep;35(9):1075-81
pubmed: 12219179
Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):608-13
pubmed: 11254512
Front Neurol. 2020 Nov 13;11:566825
pubmed: 33281703
Front Physiol. 2021 Aug 25;12:708061
pubmed: 34512381
Brain Behav Immun. 2015 Jul;47:211-7
pubmed: 25535861
Neuroimage. 2011 Jan 15;54(2):787-93
pubmed: 20888921
Sleep Breath. 2008 Nov;12(4):311-6
pubmed: 18516636
Stroke. 2021 Jan;52(2):712-715
pubmed: 33272126
Am J Respir Crit Care Med. 2003 Dec 15;168(12):1512-9
pubmed: 14525799
J Neurol Neurosurg Psychiatry. 2006 Oct;77(10):1143-9
pubmed: 16772358
Hypoxia (Auckl). 2016 Apr 27;4:99-108
pubmed: 27800512
J Appl Physiol (1985). 1989 Feb;66(2):808-13
pubmed: 2540141
Sleep. 2000 Mar 15;23(2):165-70
pubmed: 10737333
J Appl Physiol (1985). 2010 Feb;108(2):430-5
pubmed: 19875707
Hypertension. 2004 Jan;43(1):18-24
pubmed: 14662649
Am J Physiol Heart Circ Physiol. 2012 Nov 15;303(10):H1183-98
pubmed: 22982780
Sleep. 2007 Sep;30(9):1173-80
pubmed: 17910389
Sleep Breath. 2021 Sep;25(3):1641-1653
pubmed: 33037528
J Cell Mol Med. 2017 May;21(5):1024-1032
pubmed: 27957792
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104876
pubmed: 32417236
Sleep Med. 2006 Aug;7(5):424-30
pubmed: 16740405
Arterioscler Thromb Vasc Biol. 2002 Mar 1;22(3):438-42
pubmed: 11884287
Sleep. 2011 Sep 01;34(9):1271-7
pubmed: 21886365
Neuroscience. 2004;126(2):313-23
pubmed: 15207349
Vascul Pharmacol. 2015 Sep;72:83-92
pubmed: 25872163
Stroke. 2009 Apr;40(4):1091-7
pubmed: 19211495
N Engl J Med. 2005 Nov 10;353(19):2034-41
pubmed: 16282178
J Stroke Cerebrovasc Dis. 2018 Nov;27(11):2973-2976
pubmed: 30072179
J Hypertens. 2000 Jun;18(6):679-85
pubmed: 10872551
J Appl Physiol (1985). 2012 Feb;112(3):403-10
pubmed: 22096117
Chin J Physiol. 2011 Dec 31;54(6):385-90
pubmed: 22229505
Chest. 2002 Jan;121(1):164-72
pubmed: 11796446
Am J Respir Crit Care Med. 2002 Nov 15;166(10):1388-95
pubmed: 12421747
Clin Rehabil. 1999 Jun;13(3):268-72
pubmed: 10392654
Stroke. 1993 Jan;24(1):35-41
pubmed: 7678184
Eur Respir Rev. 2019 Nov 6;28(154):
pubmed: 31694839