A conversation with Antonio Culebras, MD, Professor of Neurology, SUNY Upstate Medical University, about the association between sleep apnea and stroke.
Interviewed by Gurmeen Kaur, MBBS, Vascular Neurology Fellow, Icahn School of Medicine at Mount Sinai.
Dr. Kaur: What can you tell us about the association between sleep apnea and atrial fibrillation? What is the strength of the evidence supporting this association?
Dr. Culebras: Obstructive sleep apnea is a risk factor for stroke because of its association with systemic hypertension and other risk factors for stroke, including atrial fibrillation. The Stroke Risk in Atrial Fibrillation Working Group 2007 demonstrated a 5–10% increase in risk of stroke in patients with atrial fibrillation.
Gami et al studied a cohort of over 3000 patients over 65 years who underwent polysomnography. Over a 5-year follow-up period, nocturnal oxygen desaturations emerged as a predictor for new onset atrial fibrillation. In a study of 47 women and 111 men with subacute ischemic stroke admitted for neurorehabilitation (Chen et al, 2017), mean nocturnal desaturation was significantly associated with atrial fibrillation after adjusting for age, neck circumference, Barthel index, and high-density lipoprotein level. Poli et al also concluded that there is a strong correlation between age and sleep apnea that drives the increased frequency of stroke related to atrial fibrillation.