Raffaele Ornello, MD
Zhao YY, Javaheri S, Wang R, Guo N, Koo BB, Stein JH, et al. Associations Between Sleep Apnea and Subclinical Carotid Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis. Stroke. 2019;50:3340–3346.
Literature suggests that sleep disturbances, including sleep apnea (SA), are associated with an increased risk of stroke; however, the reasons for the association are unclear.
In their prospective observational study, the authors assessed the association between sleep disturbances and indirect markers of atherosclerosis, namely the carotid intima-media thickness (CIMT) and the presence of carotid plaque, in a multi-ethnic population of 1615 subjects aged 45-85 years. The authors found an association between SA and carotid plaque only in subjects younger than 68 years; on the other hand, decreased oxygen saturation during sleep was associated with an increase in CIMT, only in younger or black individuals.
The authors’ results suggest that the mechanisms linking sleep disturbances to carotid plaques and to increased CIMT are different and both more pronounced in younger individuals. However, the most relevant result of the study is perhaps a negative one: Habitual snoring was not associated with any increased risk of carotid atherosclerosis. The study findings are in line with the recently released 2019 AHA/ASA guidelines for the management of acute ischemic stroke, which recommend against systematic screening for SA in all patients with acute ischemic stroke.