INTERPRETATION ON THE SEVERITY LEVELS OF SLEEP DURATION AND OBSTRUCTIVE SLEEP APNEA LEADING TO STROKE : A CASE-CONTROL STUDY

Main Article Content

B.H.Varun
C. Sai Varshith
S.Umer
T Joshnavi
Dr. R. E.Ugandar
Venkata Sai Krishna Setlem
Dr.K. Anil Kumar
Dr.Nagashekhara Molugulu
Sasikala Chinnappan

Keywords

Obstructive sleep apnea(OSA), stroke, case-control study, snoring, odds ratio, berlin questionnaire, STOP-Bang questionnaire

Abstract

Background: The stroke and obstructive sleep apnea is intertwined in such a manner that obstructive sleep apnea is an independent risk factor for stroke and do explains of 30-40% of risk to stroke. But the proper evidences are still poor. Hence we explore the risk relation between obstructive sleep apnea and stroke by conducting a case-control study over a period of 6 months.


Methods: The study included both case and control groups in which the population suffering from stroke is taken as a case group and the healthy population is taken as a control group. We have used set of questtionnaires(Berlin questionnaire, STOP-Bang questionnaire, Epworth sleepiness scale) for estimating the risk of obstructive sleep apnea within the entire population and the odds ratio is calculated between the groups to estimate the amount of risk. Logistic regression is also performed to estimate the individual variable (hypertension, snoring, BMI, age, gender, neck circumference) risk for OSA.


Results: Positive association is confirmed between the stroke and obstructive sleep apnea with a 3.68 odds ratio, indicating that a person suffering from OSA is at 3.68- fold risk of developing a stroke. The variables Snoring and BP had a p-value of 0.015 and <0.001. This indicates that this influence is statistically significant. The odds ratio of Snoring was 1.73, which means that the probability of Stroke increases by 1.73 times. The odds ratio of BP was 6.99 showing a 6.99-fold greater risk for stroke occurrence. However, the variable Neck circumference had a p-value of 168 indicating that this influence is not statistically significant but had an Odds ratio of 1.45.


 Limitations: The social history of case and control groups was not considered. This and short time period could become a limitation in our study as smoking and substance abuse may contribute to OSA in the population.


 Conclusion: Our study have provided an additional insights on explaining the risk of obstructive sleep apnea to the stroke which is also stastically proved. Hence obstructive sleep apnea should also be considered as an important risk factor for the stroke to reduce the stroke occurrence.

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References

1. Mathur P, Rangamani S, Kulothungan V, Huliyappa D, Bhalla BB, Urs V. National Stroke Registry Programme in India for Surveillance and Research: Design and Methodology. Neuroepidemiology. 2020;54(6):454- 461. doi: 10.1159/000510482. Epub 2020 Oct 19. PMID: 33075771.
2. Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke. 2013 Sep;15(3):128-34. doi: 10.5853/jos.2013.15.3.128. Epub 2013 Sep 27. PMID: 24396806; PMCID: PMC3859004.
3. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015 Feb 24; 11:157-64. doi: 10.2147/VHRM.S53203. PMID: 25750539; PMCID: PMC4348138.
4. Johnson KG, Johnson DC. When will it be time? Evaluation of OSA in stroke and TIA patients. Sleep Med. 2019 Jul; 59:94-95. doi: 10.1016/j.sleep.2018.10.016. Epub 2018 Oct 29. PMID: 30503686.
5. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012 Jan 3;125(1):188-97. doi: 10.1161/CIR.0b013e3182456d46. Erratum in: Circulation. 2012 Jun 5;125(22): e1001. PMID: 22215894.
6. Carroll C, Hobart J, Fox C, Teare L, Gibson J. Stroke in Devon: knowledge was good, but action was poor. J Neurol Neurosurg Psychiatry. 2004 Apr;75(4):567-71. doi: 10.1136/jnnp.2003.018382. PMID: 15026498; PMCID: PMC1739039.
7. Ho EL, Josephson SA, Lee HS, Smith WS. Cerebrovascular complications of methamphetamine abuse. Neurocrit Care. 2009;10(3):295-305. doi: 10.1007/s12028-008-9177-5. Epub 2009 Jan 9. PMID: 19132558.
8. Bhat VM, Cole JW, Sorkin JD, Wozniak MA, Malarcher AM, Giles WH, Stern BJ, Kittner SJ. Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke. 2008 Sep;39(9):2439- 43. doi: 10.1161/STROKEAHA.107.510073. Epub 2008 Aug 14. PMID: 18703815; PMCID: PMC3564048.
9. Ponsaing LB, Lindberg U, Rostrup E, Iversen HK, Larsson HBW, Jennum P. Impaired cerebrovascular reactivity in obstructive sleep apnea: a case- control study. Sleep Med. 2018 Mar; 43:7-13. doi: 10.1016/j.sleep.2017.10.010. Epub 2017 Nov 15. PMID: 29482816
10. Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, Mehra R, Bozkurt B, Ndumele CE, Somers VK. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement from the American Heart Association. Circulation. 2021 Jul 20;144(3): e56-e67. doi: 10.1161/CIR.0000000000000988. Epub 2021 Jun 21. Erratum in: Circulation. 2022 Mar 22;145(12): e775. PMID: 34148375.
11. Lyons OD, Ryan CM. Sleep Apnea and Stroke. Can J Cardiol. 2015 Jul;31(7):918-27. doi: 10.1016/j.cjca.2015.03.014. Epub 2015 Mar 14. PMID: 26112

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