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Abstract Details

Associations between cerebral small vessel disease and obstructive sleep apnea in patients with ischemic stroke and TIA
Sleep
S6 - Sleep Medicine Highlights (4:30 PM-4:42 PM)
006

Cerebral small vessel disease (SVD) is the most common cause of vascular dementia. On MRI SVD manifests as White Matter Hyperintensities (WMH), lacunes, enlarged perivascular spaces and microbleeds. Obstructive Sleep Apnea (OSA) is the most common sleep disorder and meta-analytic data supports a relationship between OSA and SVD. The purpose of this study is to examine relationships between: (1) OSA severity and SVD (2) OSA severity, SVD and cognition.

(1) To examine the relationship between OSA severity and Small Vessel Disease (SVD) in patients with ischemic stroke/TIA. (1a) To assess whether these associations may be present only in select brain regions with specific types of SVD. (2) To examine the relationship between OSA, SVD and cognition.

Patients with ischemic stroke/TIA were prospectively recruited across three independent cohort studies. Years of education, vascular risk factors, stroke severity and Montreal Cognitive Assessment scores were collected. All patients completed MRI and either an in-laboratory polysomnography (PSG) or Home Sleep Apnea Test (HSAT). OSA severity was quantified using the Apnea Hypopnea Index (AHI). The burden of small vessel disease was quantified using validated visual rating scales. Ordinal logistic regression models examined relationships between OSA and SVD, while controlling for covariates.

In 237 patients increasing AHI was associated with a greater burden of periventricular WMH (pWMH) OR=1.02 (CI:1.01 to 1.04, p=0.02), deep microbleeds OR=1.03 (CI:1.01 to 1.05, p=0.002) and lobar microbleeds OR=1.02 (CI:1.01 to 1.04, p=0.03). Finally, in an ordinal logistic regression model, lower cognitive scores were related to cerebral microbleeds OR=1.09 (CI:1.01 to 1.18, p = 0.03) while controlling for covariates.

OSA severity is associated with greater periventricular WMH and cerebral microbleeds. Cerebral microbleeds are predictive of lower cognitive scores. The relationship between OSA and both lobar and deep microbleeds suggests potential associations with nocturnal hypertension and cerebral amyloid clearance.

Authors/Disclosures
Ryan Thomas Muir, MD (Stroke Prevention Clinic, Clinical Neurosciences, Foothills Medical Centre )
PRESENTER
Dr. Muir has nothing to disclose.
Laavanya Dharmakulaseelan, MD Ms. Dharmakulaseelan has nothing to disclose.
Sandra E. Black, MD, FAAN (Sunnybrook Health Science Center) Dr. Black has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Hoffmann-La Roche. Dr. Black has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Black has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Hoffmann-La Roche. Dr. Black has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Black has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai Limited . Dr. Black has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Black has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Black has received research support from Hoffmann-La Roche. The institution of Dr. Black has received research support from Biogen. The institution of Dr. Black has received research support from GE Healthcare. The institution of Dr. Black has received research support from Eli Lilly. The institution of Dr. Black has received research support from Genentech. The institution of Dr. Black has received research support from NovoNordisk. The institution of Dr. Black has received research support from UCB Biopharma. The institution of Dr. Black has received research support from Alkahest Inc. The institution of Dr. Black has received research support from University of Southern California - AHEAD 3-45 Study.
Brian James Murray, MD, FAAN The institution of Dr. Murray has received research support from Wake Up Narcolepsy. Dr. Murray has received publishing royalties from a publication relating to health care.
Mark Boulos, MD (Sunnybrook Health Sciences Centre) Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz Pharmaceuticals. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Paladin Labs. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. The institution of Dr. Boulos has received research support from Canadian Institutes of Health Research. The institution of Dr. Boulos has received research support from Slamen-Fast New Initiatives in Neurology Award. The institution of Dr. Boulos has received research support from Green Mountain . The institution of Dr. Boulos has received research support from RLS Foundation. The institution of Dr. Boulos has received research support from Temerty Centre for AI Research and Education in Medicine (T-CAIREM). The institution of Dr. Boulos has received research support from Heart & Stroke Foundation of Canada. The institution of Dr. Boulos has received research support from Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. Dr. Boulos has received personal compensation in the range of $5,000-$9,999 for serving as a speaker with Jazz Pharmaceuticals.