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

Jessica Kepplinger, Kristian Barlinn, Amelia K. Boehme, Johannes Gerber, Volker Puetz, Lars Peder Pallesen, Wiebke Schrempf, Imanuel Dzialowski, Karen C. Albright, Andrei Alexandrov, Heinz Reichmann, Ruediger Von Kummer, Ulf Bodechtel

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)343-349
Number of pages7
JournalJournal of Neurology
Volume261
Issue number2
DOIs
StatePublished - Jan 1 2014

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Sleep Apnea Syndromes
Leukoaraiosis
Brain Ischemia
Apnea
Brain
Lacunar Stroke
Sleep
Stroke
Tomography
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Kepplinger, J., Barlinn, K., Boehme, A. K., Gerber, J., Puetz, V., Pallesen, L. P., ... Bodechtel, U. (2014). Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia. Journal of Neurology, 261(2), 343-349. https://doi.org/10.1007/s00415-013-7200-z

Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia. / Kepplinger, Jessica; Barlinn, Kristian; Boehme, Amelia K.; Gerber, Johannes; Puetz, Volker; Pallesen, Lars Peder; Schrempf, Wiebke; Dzialowski, Imanuel; Albright, Karen C.; Alexandrov, Andrei; Reichmann, Heinz; Von Kummer, Ruediger; Bodechtel, Ulf.

In: Journal of Neurology, Vol. 261, No. 2, 01.01.2014, p. 343-349.

Research output: Contribution to journalArticle

Kepplinger, J, Barlinn, K, Boehme, AK, Gerber, J, Puetz, V, Pallesen, LP, Schrempf, W, Dzialowski, I, Albright, KC, Alexandrov, A, Reichmann, H, Von Kummer, R & Bodechtel, U 2014, 'Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia', Journal of Neurology, vol. 261, no. 2, pp. 343-349. https://doi.org/10.1007/s00415-013-7200-z
Kepplinger, Jessica ; Barlinn, Kristian ; Boehme, Amelia K. ; Gerber, Johannes ; Puetz, Volker ; Pallesen, Lars Peder ; Schrempf, Wiebke ; Dzialowski, Imanuel ; Albright, Karen C. ; Alexandrov, Andrei ; Reichmann, Heinz ; Von Kummer, Ruediger ; Bodechtel, Ulf. / Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia. In: Journal of Neurology. 2014 ; Vol. 261, No. 2. pp. 343-349.
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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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