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REPLY
Obstructive Sleep Apnea and Stroke
Sean M. Caples, DO, and
Virend K. Somers, MD, PhD
6 September 2005 | Volume 143 Issue 5 | Page 390
IN RESPONSE:
We thank Dr. Madan for these comments about the association between obstructive sleep apnea and stroke. Because of the abundance of data published on obstructive sleep apnea, we limited our discussion of disease associations to those with the highest level of published evidence. The Sleep Heart Health Study has generated large amounts of data and has yielded a number of important publications. However, current evidence does not support a causal role of obstructive sleep apnea in stroke. Rather, studies like the Sleep Heart Health Study suggest that obstructive sleep apnea is prevalent in those who have a history of stroke (1).
As Madan suggests, confidently implicating obstructive sleep apnea in the etiology of cerebrovascular disease will require rigorous, long-term prospective data. Moreover, it has been shown that stroke may actually cause transient centrally mediated apnea. That said, the hemodynamic and hemostatic changes seen in obstructive sleep apnea, along with indirect effects related to the high prevalence of concomitant systemic hypertension, suggest a potentially important role of obstructive sleep apnea in cerebrovascular disease. Available evidence, however, has been conflicting. A prospective cohort study of patients admitted for stroke or transient ischemic attack demonstrated a higher prevalence of obstructive sleep apnea than in the general population (2). This was not the case in a small case–control study of patients with transient ischemic attack, which showed no significant difference in the severity or prevalence of obstructive sleep apnea between groups (3).
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Author and Article Information
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From Mayo Clinic, Rochester, MN 55905.
Potential Financial Conflicts of Interest: None disclosed.
1. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19-25. [PMID: 11208620].
2. Parra O, Arboix A, Bechich S, Garcia-Eroles L, Montserrat JM, Lopez JA, et al. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med. 2000;161:375-80. [PMID: 10673174].
3. McArdle N, Riha RL, Vennelle M, Coleman EL, Dennis MS, Warlow CP, et al. Sleep-disordered breathing as a risk factor for cerebrovascular disease: a case-control study in patients with transient ischemic attacks. Stroke. 2003;34:2916-21. [PMID: 14657548].
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Reviews
Obstructive Sleep Apnea
Sean M. Caples, Apoor S. Gami, AND Virend K. Somers
- Annals 2005 142: 187-197.
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