Obstructive and Central Sleep Apnea in First Ever Ischemic Stroke are Associated with Different Time Course and Autonomic Activation

Figures & data

Table 1 Demographic and Clinical Data

	No-SDB (n=15)	d-OSA (n=27)	d-CSA (n=11)	MP (n=14)	Total (n=67)	p
Age (years)	58.1±8.3	62.2±9.9	61.8±7.7	60.2±11.8	60.8±9.6	n.s.
BMI (kg/m^2)	23.8±3.4	28.1±4.3	27±3.1	27.6±4.5	26.8±4.2	0.01
NIHSS	0.93±1.2	1.1±2	1.5±2.2	1.3±1.6	1.2±1.8	n.s.
EF (%)	58.7±7.2	60.2±3.7	58.2±6.8	60.7±5.3	59.6±5.5	n.s.
FVC (%)	104.3±18	95.9±20	103.4±15.1	101.5±21.9	100.1±19.3	n.s.
FEV1 (%)	96±19	91±20.7	100.9±14.5	98.9±20.2	95.4±19.7	n.s.
FEV1/FVC	74.4±8.1	76.3±8.6	77.3±7.7	78±6.9	76.4±7.9	n.s.
ESS	7.4±4.7	10±6.3	6.7±3.5	9.1±6.7	8.7±5.7	n.s.
Hypertension (%)	73.3	74.1	81.8	64.3	73.1	n.s.
Diabetes (%)	13.3	25.9	18.2	21.4	20.9	n.s.

Note: Data are presented as mean ± SD unless otherwise indicated.

Abbreviations: BMI, body mass index; NIHSS, NIH Stroke Scale; EF, ejection fraction; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; ESS, Epworth Sleepiness Score; No-SDB, no sleep-disordered breathing; d-OSA, dominant obstructive sleep apnea pattern; d-CSA, dominant central sleep apnea pattern; MP, mixed pattern.

Table 2 Respiratory Polygraphic Indices

	No-SDB (n=15)	d-OSA (n=27)	d-CSA (n=11)	MP (n=14)	Total (n=67)	p
AHI	5.2±2	22.6±14.7	31.9±15.7	27.9±16.9	21.4±16.3	<0.0001
Supine AHI	9.1±4.6	35.1±18.3	43.2±19.3	43.9±22.6	32.7±21.7	<0.0001
AHIo	2.7±1.4	20.6±15.1	4.9±3.9	14.3±9.9	12.8±13	<0.0001
AHIc	2.3±2	2.4±2.9	27.5±15.1	13.4±8.3	8.7±11.6	<0.0001
MCA s	15±3.9	14.6±2.2	17.4±2.7	16.1±2.4	15.5±2.8	n.s.
MOA s	10±8.2	19.3±4.6	16.7±3.4	15.9±3.1	16±6.3	<0.001
Mean SpO2%	93.1±1.7	91.9±1.7	92.2±2.1	91.7±1.5	92.2±1.8	n.s.
SpO2 %nadir	84.9±6.1	78.4±9.2	78.6±5.8	80.2±5.6	80.3±7.7	0.05
Mean amplitude %	3.6±0.4	4.2±0.9	4.2±1.1	4.2±0.8	4.1±0.9	n.s.
ODI	5.6±2.9	22.3±13.3	29.4±15	26.9±16.8	20.7±15.3	<0.001
T90%	8.2±19.4	14.5±16.2	12.6±16.3	13.7±15.7	12.6±16.6	n.s.

Note: Data are presented as mean ± SD.

Abbreviations: AHI, Apnea–Hypopnea Index; AHIo, obstructive AHI; AHIc, central AHI; MCA, mean duration of central apnea; MOA, mean duration of obstructive apnea; Mean SpO₂, mean oxygen saturation value; SpO₂, nadir minimum oxygen saturation value; Mean amplitude, mean amplitude of desaturation; ODI, oxygen desaturation index; T₉₀, recording time with SpO₂ <90%; No-SDB, no sleep-disordered breathing; d-OSA, dominant obstructive sleep apnea pattern; d-CSA, dominant central sleep apnea pattern; MP, mixed pattern.

Figure 1 Flow diagram of the study.

Table 3 Neurovegetative Data Categorized According to SDB Pattern and Presence/Absence of Arterial Hypertension at Baseline

		No-SDB	d-OSA	d-CSA	MP	p
	Hypertension
BRS	No	10.8±7.8	8.4±3.7	25.1±19.9°	8.1±3	<0.01
	Yes	8.3±6.1	5.8±3.9	9.4±6.9°	5.9±3.5
ANSI	No	36.9±30.9	48.4±33.1	87.8±2.8	47.4±41.7	n.s.
	Yes	41.2±25	41.9±31.7	53.8±37.5	39.4±29.6
Alpha M	No	15±7.1	10.3±4.4	32.8±19.2*	7.7±2.8	<0.01
	Yes	8±5.2	10.8±6.9	9.4±5.3*	8.7±3
HR (beats/min)	No	73±5.4	65.7±11	50±5.7	68.9±15.5	n.s.
	Yes	65.6±12.1	66.6±11.4	62.8±13.6	66.3±8.9
RR	No	825±58	937.5±162	1208.4±137.3	905.6±198.2	n.s.
	Yes	943.5±180.5	926±161	992.5±189	919.5±127.6
RR LF/HF	No	2.4±3.3	2.1±3	0.86±0.1	2.6±3.4	n.s.
	Yes	2.1±2.8	3.9±4.6	3.4±7.5	4.7±3.9

Notes: Data are presented as mean ± SD. ° and * Intragroup post-hoc analysis.

Abbreviations: SDB, sleep-disordered breathing; BRS, time domain baroreflex sensitivity; ANSI, Autonomic Nervous System Index; Alpha M, frequency domain baroreflex gain; HR, heart rate; RR, RR interval; LF/HF, ratio of low frequency/high frequency; RR, R-R interval variability spectral power; No-SDB, no sleep-disordered breathing; d-OSA, dominant obstructive sleep apnea pattern; d-CSA, dominant central sleep apnea pattern; MP, mixed pattern.

Table 4 Neurovegetative Data Categorized According to SDB Pattern and Site of Ischemic Stroke at Baseline

		No-SDB	d-OSA	d-CSA	MP	p
	Site
BRS	Supra	9.4±7.8	6.7±3.9	8.5±6.1°	7.5±3.6	<0.001
	Infra	8.2±3.3	6±4.8	29±14.5°	6.7±3.3
ANSI	Supra	33.5±18.9	44.1±33	54.8±38.3	29.3±21.2	n.s.
	Infra	51.7±33.3	41.9±27.8	83.2±9.3	53.7±38.9
Alpha M	Supra	9.9±7.1	10.8±5.1	9.8±6*	8.1±2.9	0.004
	Infra	9.6±5.5	10.3±10.2	30.6±22.2*	8.4±3
AHI	Supra	5.6±2.3	24.4±15.8	36±14.4	29±16.5	<0.001
	Infra	4.5±1.3	14.8±5	13.8±0.6	27±18.6
AHIo	Supra	2.7±1.2	22.7±16.3	5.7±4.2	13.7±7.5	<0.001
	Infra	2.8±1.9	12.8±4.4	2.4±1.2	14.9±12.5
AHIc	Supra	2.7±2.3	2.5±3.1	32.1±13.8	15.1±9.6	<0.001
	Infra	1.7±1.3	2±2.2	11.2±0.8	11.7±7.1

Note: Data are presented as mean ± SD. ° and * Intragroup post-hoc analysis.

Abbreviations: SDB, sleep-disordered breathing; BRS, time domain baroreflex sensitivity; ANSI, Autonomic Nervous System Index; Alpha M, frequency domain baroreflex gain; AHI, ApnEa–Hypopnea Index; AHIo, obstructive AHI; AHIc, central AHI; No-SDB, no sleep-disordered breathing; d-OSA, dominant obstructive sleep apnea pattern; d-CSA, dominant central sleep apnea pattern; MP, mixed pattern.

Table 5 Sleep Data at Follow-Up Categorized According to Baseline SDB Pattern

	No-SDB (n=7)	d-OSA (n=37)	d-CSA (n=4)	MP (n=12)	Total (n=60)	p
Age (years)	58.3±8	62.1±9.7	62±7.7	59.4±11.8	60.7±9.4	n.s.
BMI (kg/m^2)	23.6±3.5	27.7±4.8	27.2±2.2	27.5±3.8	26.7±4.2	0.02
ESS						n.s.
AHI	7.2±3.9	21.1±16.3	25.1±15	15.7±11	17.7±14.3	<0.001
AHI supine	17.6±11	37±28.7	36.1±22.5	28±15.5	30.5±22.7	n.s.
AHIo	5.2±3.8	16.8±11.3	14.7±14.1	11.2±10.3	12.4±11.1	0.02
AHIc	2±2.6	1.6±1.5	10.3±9	4.3±2.9	3.9±5.2	<0.0001
MCA s	13.5±2.6	15±3.4	17.6±3.6	14.9±2.7	15.1±2.7	n.s.
MOA s	12.7±10.1	19.4±4.5	20±3.9	16±6.7	17.1±7.1	0.02
Mean SpO2%	92.7±1.4	92.1±1.8	91.4±1.3	91.7±1.9	92±1.7	n.s.
SpO2 nadir %	85.8±5.5	77.5±9.9	80.4±5.3	82.2±5.9	80.8±7.9	0.01
ODI	7.5±4.3	20.7±14.9	25.4±14.2	16.3±11.1	17.7±13.6	<0.01
T90%	4.1±8.7	12.5±13.4	17.5±18.8	15.5±21.8	12.1±16.2	n.s.

Note: Data are presented as mean ± SD unless otherwise indicated.

Abbreviations: SDB, sleep-disordered breathing; BMI, body mass index; ESS, Epworth Sleepiness Score; AHI, ApnEa–Hypopnea Index; AHIo, obstructive AHI; AHIc, central AHI; MCA, mean duration of central apnea; MOA, mean duration of obstructive apnea; Mean SpO₂, mean oxygen saturation; SpO₂, nadir minimum oxygen saturation value; ODI, oxygen desaturation index; T₉₀, recording time with SpO₂ <90%; No-SDB, no sleep-disordered breathing; d-OSA, dominant obstructive sleep apnea pattern; d-CSA, dominant central sleep apnea pattern; MP, mixed pattern.

Table 6 Sleep and Autonomic Data at Follow-Up for Each Group According to Site of Ischemic Stroke and SDB Pattern Observed in the Chronic Phase

		No-SDB	d-OSA	d-CSA	MP	p
	Side
BRS	Supra	11.1±9.4	11.2±10.6	5.9±0.3	8.1±5.1	n.s.
	Infra	13.2±5.6	9.2±9.5	27.2±0.01	61.7±105
Alpha M	Supra	8.6±5.2	13.9±15.1	8±2.8	6.8±4.2	n.s.
	Infra	19.1±16.7	7.7±6	25.6±0.2	18.5±13
AHI	Supra	3.4±1.7	24.4±17.3	24.8±17.6	15.9±8.6	0.02
	Infra	3.2±1.8	12.6±3.3	7.5±0.1	14.9±4.9
AHIo	Supra	2.4±1.3	19.5±13.5	5.5±6.5	9.3±5.5	0.03
	Infra	1±0.9	11.3±3.1	1±0.05	7.6±3.6
AHIc	Supra	0.9±0.6	2.2±2.7	19.3±11.1	6.7±3.5	<0.001
	Infra	2.1±2.7	1.2±1.1	6.5±0.05	6.7±1.9

Note: Data are presented as mean ± SD.

Abbreviations: SDB, sleep-disordered breathing; BRS, time domain baroreflex sensitivity; Alpha M, frequency domain baroreflex gain; AHI, Apnea–Hypopnea Index; AHIo, obstructive AHI; AHIc, central AHI; No-SDB, no sleep-disordered breathing; d-OSA, dominant obstructive sleep apnea pattern; d-CSA, dominant central sleep apnea pattern; MP, mixed pattern; Supra, supratentorial; Infra, infratentorial.

Table 7 Individual Changes in SDB Patterns Between Baseline and Follow-Up

	Follow-Up
Baseline		No-SDB	d-OSA	d-CSA	MP	Totals
	No-SDB	5	6	1	1	13
	d-OSA	1	21	0	1	23
	d-CSA	1	4	2	4	11
	MP	0	6	1	6	13
	Totals	7	37	4	12	60

Abbreviations: SDB, sleep-disordered breathing; No-SDB, no sleep-disordered breathing; d-OSA, dominant obstructive sleep apnea pattern; d-CSA, dominant central sleep apnea pattern; MP, mixed pattern.

Figure 2 Changes in global (A), obstructive (B) and central AHI (C) between acute and chronic phases in the four groups of patients, separately for SDB pattern at baseline.

Figure 3 Modification over time of BRS evaluated according to the site of lesion and the pattern of SDB.

Figure 4 Trend of ANSI between acute and chronic phases according to site of ischemic lesion.