Atrial fibrillation is a major cause of stroke in apneic patients: a prospective study

Publication date: Available online 4 March 2016
Source:Sleep Medicine
Author(s): M Poli, P Philip, J Taillard, S Debruxelles, P Renou, JM Orgogozo, F Rouanet, I Sibon
ObjectivesLarge prospective studies have established that sleep-disordered breathing(SDB) is associated with an increased incidence of cardiovascular and cerebrovascular diseases. Heterogeneous results have been published about SDB and ischemic stroke mechanism. The aim of this study was to evaluate the relationship between post-stroke apneic syndrome and stroke etiologies according to the ASCO classification.Methods134 patients with acute ischemic cerebrovascular events were prospectively included. Patients with severe or infratentorial infarctions were excluded. Stroke risk factors and clinical characteristics were recorded in all patients. An overnight polygraphy was recorded (Embletta PDS). Apneic patients were defined if the polygraphy reported an apnea/hypopnea index ≥ 15. A standardized diagnosis work-up including serum biological investigation, evaluation of extra and intracranial arteries and heart morphology and function was performed. Stroke mechanism was defined using ASCO and TOAST classifications.Results56 of the 134 patients (42%) were diagnosed as having sleep apneas. Apneic patients were older (p<0.001), had higher BMI (p=0.02) and more often had hypertension (p<0.001). Using ASCO classification, a major cardioembolic source of stroke, mainly atrial fibrillation, was more frequently observed in apneic patients (41.1% vs 20.5%, p<0.05) while no difference was observed when considering atherosclerosis or small vessel disease mechanisms. Univariate analysis showed that cardioembolic stroke was related to sex, age, left atrial size and OSA but age remained the only significant factor on multivariate analysis.ConclusionThe present study confirms the high prevalence of sleep apneas in stroke patients and identifies atrial fibrillation as a major source of stroke in this population. The strong relationship between age and sleep disordered breathing seems to drive the increased frequency of stroke related to atrial fibrillation in this population.



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