People with Sleep Apnea at Higher Risk of Stroke

People with sleep-related breathing disorders, such as habitual snoring and sleep apnea, are at higher risk of suffering a stroke, according to a study by a Yale researcher published in the June issue of the journal Stroke.

“Sleep-related breathing disorders are strongly associated with increased risk of stroke independent of known risk factors,” said Vahid Mohsenin, M.D., director of the Yale Center for Sleep Disorders and principal investigator of the study. “Since sleep-related breathing disorders are treatable, patients with stroke and transient ischemic attacks should be investigated for these conditions.”

Stroke, according to the American Heart Association, is the third leading cause of death in the United States after coronary heart disease and cancer. There are about 600,000 cases of stroke each year and 150,000 are fatal.

Mohsenin said there have been recent studies showing a strong association between stroke and sleep-related breathing disorders. His study suggests that sleep-related breathing disorders are modifiable risk factors for stroke.

“The mechanisms underlying this increased risk of stroke are multifactorial and include: reduction in cerebral blood flow, altered cerebral autoregulation, and increased platelet aggregation and plasma fibrinogen level,” he said.

The most common presentation of sleep apnea disorder is excessive daytime sleepiness and unrefreshing sleep, he said, adding that many people describe falling asleep during socially inappropriate occasions.

“Intermittent snoring with breath holding terminated by loud snorts and body movements is a typical feature that patients may not be able to report about themselves,” Mohsenin said. “A detailed history from a bed partner, when there is one, is of crucial importance.”

Other related complaints include restless sleep, choking or coughing during sleep, excessive urination at night, and headaches. Physical examination of the upper airways may disclose, among other conditions, a deviated nasal septum, an enlarged tongue, a redundant soft palate, or paralyzed vocal cords.

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