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  • Obstructive sleep apnea confers lower mortality risk in acute ischemic stroke patients treated with endovascular thrombectomy: National Inpatient Sample analysis 2010–2018

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Vascular neurology
Original research
Obstructive sleep apnea confers lower mortality risk in acute ischemic stroke patients treated with endovascular thrombectomy: National Inpatient Sample analysis 2010–2018
  1. Justin M Lapow1,
  2. Alis J Dicpinigaitis1,
  3. Rajkumar S Pammal1,
  4. Griffin A Coghill1,
  5. Osher Rechester2,
  6. Eric Feldstein3,
  7. Rolla Nuoman4,
  8. Kristina Maselli2,
  9. Shyla Kodi1,2,
  10. Andrew Bauerschmidt5,
  11. Jon B Rosenberg5,
  12. Shadi Yaghi6,
  13. Gurmeen Kaur7,
  14. Christeen Kurian4,
  15. Ji Y Chong4,7,
  16. Stephan A Mayer4,
  17. Chirag D Gandhi7,
  18. Fawaz Al-Mufti5
  1. 1 New York Medical College School of Medicine, Valhalla, New York, USA
  2. 2 Westchester Medical Center, Valhalla, New York, USA
  3. 3 Neurosurgery, New York Medical College Department of Neurosurgery, Valhalla, New York, USA
  4. 4 Neurology, Westchester Medical Center, Valhalla, New York, USA
  5. 5 Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
  6. 6 Department of Neurology, Brown University, Providence, Rhode Island, USA
  7. 7 Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
  1. Correspondence to Dr Fawaz Al-Mufti, Neurosurgery, Westchester Medical Center, Valhalla, New York, USA; fawaz.al-mufti{at}wmchealth.org

Background

Obstructive sleep apnea (OSA) portends increased morbidity and mortality following acute ischemic stroke (AIS). Evaluation of OSA in the setting of AIS treated with endovascular mechanical thrombectomy (MT) has not yet been evaluated in the literature.

Methods The National Inpatient Sample from 2010 to 2018 was utilized to identify adult AIS patients treated with MT. Those with and without OSA were compared for clinical characteristics, complications, and discharge disposition. Multivariable logistic regression analysis and propensity score adjustment (PA) were employed to evaluate independent associations between OSA and clinical outcome.

Results Among 101 093 AIS patients treated with MT, 6412 (6%) had OSA. Those without OSA were older (68.5 vs 65.6 years old, p<0.001), female (50.5% vs 33.5%, p<0.001), and non-caucasian (29.7% vs 23.7%, p<0.001). The OSA group had significantly higher rates of obesity (41.4% vs 10.5%, p<0.001), atrial fibrillation (47.1% vs 42.2%, p=0.001), hypertension (87.4% vs 78.5%, p<0.001), and diabetes mellitus (41.2% vs 26.9%, p<0.001). OSA patients treated with MT demonstrated lower rates of intracranial hemorrhage (19.1% vs 21.8%, p=0.017), treatment of hydrocephalus (0.3% vs 1.1%, p=0.009), and in-hospital mortality (9.7% vs 13.5%, p<0.001). OSA was independently associated with lower rate of in-hospital mortality (aOR 0.76, 95% CI 0.69 to 0.83; p<0.001), intracranial hemorrhage (aOR 0.88, 95% CI 0.83 to 0.95; p<0.001), and hydrocephalus (aOR 0.51, 95% CI 0.37 to 0.71; p<0.001). Results were confirmed by PA.

Conclusions Our findings suggest that MT is a viable and safe treatment option for AIS patients with OSA.

  • thrombectomy
  • stroke

Data availability statement

Data are available in a public, open access repository. N/A.

https://doi.org/10.1136/neurintsurg-2021-018161

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    Data availability statement

    Data are available in a public, open access repository. N/A.

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    Footnotes

    • Twitter @Eric_Feldstein, @almuftifawaz

    • Contributors Substantial contributions to the conception or design of the work was done by JL, AD, RP, and GC. Acquisition, analysis, and interpretation of data for this manuscript conducted by JL, AD, EF, RL, KM, SK, AB, JR, SY, GK, CK, JC, SM, CG, and FM. Drafting and revision performed by all authors. Final approval of the version to be published done by all authors. All authors agree to be accountable for all aspects of this work in ensuring that questions related to the accuracy or integrity of any part of this work are appropriately investigated and resolved. FM acts as guarantor for this study, had full access to data, controlled decision to publish, and accepts full responsibility for the conduct and finished work of this study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.