Clinical phenotypes of obstructive sleep apnea after ischemic stroke: a cluster analysis

Sonja G Schütz; Lynda D Lisabeth; Fatema Shafie-Khorassani; Erin Case; Brisa N Sanchez; Ronald D Chervin; Devin L Brown

doi:10.1016/j.sleep.2019.04.004

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Clinical phenotypes of obstructive sleep apnea after ischemic stroke: a cluster analysis

Journal article

Open access

Peer reviewed

Clinical phenotypes of obstructive sleep apnea after ischemic stroke: a cluster analysis

Sonja G Schütz, Lynda D Lisabeth, Fatema Shafie-Khorassani, Erin Case, Brisa N Sanchez, Ronald D Chervin and Devin L Brown

Sleep medicine, v 60, pp 178-181

Aug 2019

DOI: https://doi.org/10.1016/j.sleep.2019.04.004

PMID: 31186211

Featured in Collection : UN Sustainable Development Goals @ Drexel

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424592View

Accepted (AM)Open Access (License Unspecified), Open

Abstract

Cluster analysis

Cerebrovascular accident

Stroke

Latent class analysis

Obstructive sleep apnea

Sleep-disordered breathing

Obstructive sleep apnea (OSA) is highly prevalent in patients with ischemic stroke. Untreated OSA is associated with an increased risk of cardiovascular morbidity and OSA treatment may improve neurological recovery in stroke survivors, yet OSA in stroke patients remains poorly characterized. The goal of this study is to identify clinical phenotypes of ischemic stroke patients with OSA. Participants (n = 451) with ischemic strokes and OSA (respiratory-event-index, (REI) ≥ 10/hour based on home sleep apnea testing) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Latent class analysis was performed based on the following variables: age, sex, race/ethnicity, REI, pre-stroke snoring, pre-stroke tiredness/fatigue, pre-stroke sleep duration, prior stroke history, NIHSS at presentation, body mass index (BMI), hypertension, diabetes, atrial fibrillation, coronary artery disease, and chronic heart failure. A model with three phenotype clusters provided the best fit. Cluster 1 (n = 55, 12%) was defined by higher NIHSS scores. Participants in cluster 2 (n = 253, 56%) were younger and had relatively low NIHSS scores. Cluster 3 (n = 143, 32%) included participants with severe OSA and higher prevalence of medical comorbidities. Ischemic stroke survivors with OSA can be categorized into three clinical phenotype clusters characterized by differences in stroke severity, OSA severity, age and medical comorbidities. This highlights the heterogeneity of post-stroke OSA. Awareness of the different faces of OSA in patients with ischemic stroke may help clinicians identify OSA in their patients, and inform research concerning the pathophysiology, treatment and prognostic impact of post-stroke OSA.

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Details

Title: Clinical phenotypes of obstructive sleep apnea after ischemic stroke: a cluster analysis
Creators: Sonja G Schütz - University of Michigan
Lynda D Lisabeth - University of Michigan
Fatema Shafie-Khorassani - University of Michigan
Erin Case - University of Michigan
Brisa N Sanchez - Drexel University
Ronald D Chervin - University of Michigan
Devin L Brown - University of Michigan
Publication Details: Sleep medicine, v 60, pp 178-181
Publisher: Elsevier
Grant note: R01 HL126700 / NHLBI NIH HHS R01 NS070941 / NINDS NIH HHS R01 NS038916 / NINDS NIH HHS R01 HL123379 / NHLBI NIH HHS R01 HL098065 / NHLBI NIH HHS
Resource Type: Journal article
Language: English
Academic Unit: Epidemiology and Biostatistics
Web of Science ID: WOS:000473718100025
Scopus ID: 2-s2.0-85067072927
Other Identifier: 991020099919304721

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Collaboration types: Domestic collaboration
Web of Science research areas: Clinical Neurology