Sleep‐disordered breathing and poststroke outcomes

Objective To examine the association between sleep‐disordered breathing and stroke outcomes, and determine the contribution of sleep‐disordered breathing to outcome disparities in Mexican Americans. Methods Ischemic stroke patients (n = 995), identified from the population‐based Brain Attack Surveillance in Corpus Christi Project (2010–2015), were offered participation in a sleep‐disordered breathing study including a home sleep apnea test (ApneaLink Plus). Sleep‐disordered breathing (respiratory event index ≥10) was determined soon after stroke. Neurologic, functional, cognitive, and quality of life outcomes were assessed at 90 days poststroke. Regression models were used to assess associations between sleep‐disordered breathing and outcomes, adjusted for sociodemographics, prestroke function and cognition, health‐risk behaviors, stroke severity, and vascular risk factors. Results Median age was 67 years (interquartile range [IQR] = 59–78); 62.1% were Mexican American. Median respiratory event index was 14 (IQR = 6–25); 62.8% had sleep‐disordered breathing. Sleep‐disordered breathing was associated with worse functional outcome (mean difference in activities of daily living/instrumental activities of daily living score = 0.15, 95% confidence interval [CI] = 0.01–0.28) and cognitive outcome (mean difference in modified Mini‐Mental State Examination = −2.66, 95% CI = −4.85 to −0.47) but not neurologic or quality of life outcomes. Sleep‐disordered breathing accounted for 9 to 10% of ethnic differences in functional and cognitive outcome and was associated with cognitive outcome more strongly for Mexican Americans (β = −3.97, 95% CI = −6.63 to −1.31) than non‐Hispanic whites (β = −0.40, 95% CI = −4.18 to 3.39, p ‐interaction = 0.15). Interpretation Sleep‐disordered breathing is associated with worse functional and cognitive function at 90 days poststroke. These outcomes are reasonable endpoints for future trials of sleep‐disordered breathing treatment in stroke. If effective, sleep‐disordered breathing treatment may somewhat lessen ethnic stroke outcome disparities. ANN NEUROL 2019;86:241–250