Influence of Obstructive Sleep Apnea on Cardioembolic Stroke Severity and Outcomes in Patients with Atrial Fibrillation
Lina Y. Zubalova1 *, Lilit G. Minasyan1, Marine K. Balasanyan1, Manya A. Margaryan1, Oganes M. Ezoyan1,
Lusine G. Madoyan1, David A. Sahakyan1, Aleksan A. Petrosyan1, David L. Margaryan1,
Nune S. Yeghiazaryan1, Samson G. Khachatryan2,3, Manvel N. Aghasaryan4
1 Erebouni Medical Center, Yerevan, Armenia
2 Department of Neurology and Neurosurgery,
Avdalbekyan National Institute of Health,
Yerevan, Armenia
3 Somnus Neurology Clinic, Yerevan, Armenia
4 Sud Francilien Hospital Center, Corbeil-Essonnes,
France
ABSTRACT
Background: Obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF) and ischemic stroke. Approximately 25% of patients with AF have documented OSA. The potential impact of OSA on AF-related stroke outcomes remains under investigation.
Aim: To evaluate the association between OSA at the time of admission, stroke severity and outcome in AF-related acute stroke patients.
Methods: This prospective case-control study included patients with acute ischemic stroke within 7 days of onset, documented or newly diagnosed AF (paroxysmal or permanent), and CHA2DS2-VASc ≥2. Patients with other stroke etiologies or Glasgow Coma Scale <13 were excluded. Participants were grouped based on apnea-hypopnea index (AHI): <15/h and ≥15/h. The primary outcome was National Institutes of Health Stroke Scale (NIHSS) at admission; secondary outcomes included NIHSS at discharge, 3-month modified Rankin Scale (mRS), and mortality. Statistical analysis was conducted using SPSS 22.
Results: Of 745 patients screened, 118 met the criteria; 101 were included in final analysis due to technical issues in polygraphy. NIHSS scores at admission and discharge were similar across AHI groups (10.3±7.4 vs. 10.3±7.4; 4.0±4.1 vs. 3.9±4.2, respectively). No significant difference was observed in functional independence (mRS 0–2) at 3 months (66.7% vs. 73.3%) or mortality. However, multivariate analysis showed a significant inverse relationship between AHI and excellent outcome (mRS 0–1) at 3 months (p=0.005), regardless of stroke severity and recanalization. Each unit increase in AHI was associated with a 4% decrease in the likelihood of an excellent recovery.
Conclusion: OSA severity does not correlate with initial stroke severity or mortality in AF-related stroke but is independently associated with reduced odds of excellent functional recovery. Early detection of OSA may support the implementation of timely interventions, such as continuous positive airway pressure, to improve post-stroke outcomes.
Keywords: ischemic stroke; obstructive sleep apnea; atrial fibrillation; respiratory polygraphy