Heterogeneity of obstructive sleep apnea phenotypes after ischemic stroke: Outcome variation by cluster analysis

• Published in: Sleep medicine Vol. 114; pp. 145 - 150
• Main Authors: Khot, S.P., Lisabeth, L.D., Kwicklis, M., Chervin, R.D., Case, E., Schütz, S.G., Brown, D.L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2024
• Subjects: Cluster Analysis; Humans; Ischemic stroke; Ischemic Stroke - complications; Latent profile analysis; Obstructive sleep apnea; Phenotype; Quality of Life; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - epidemiology; Sleepiness; Stroke - epidemiology; Cluster analysis; NIHSS; IADL; CPAP; Latent profile analysis; SS-QOL; ADL; Ischemic stroke; Obstructive sleep apnea; 3MSE; MA; REI; OSA; LPA; NHW; Sleepiness; BMI
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2023.12.027

Obstructive sleep apnea (OSA) is common but under-recognized after stroke. The aim of this study was to determine whether post-stroke phenotypic OSA subtypes are associated with stroke outcome in a population-based observational cohort. Ischemic stroke patients (n = 804) diagnosed with OSA (respiratory event index ≥10) soon after ischemic stroke were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Functional, cognitive, and quality of life outcomes were assessed at 90 days post-stroke and long-term stroke recurrence was ascertained. Latent profile analysis was performed based on demographic and clinical features, pre-stroke sleep characteristics, OSA severity, and vascular risk factors. Regression models were used to assess the association between phenotypic clusters and outcomes. Four distinct phenotypic clusters provided the best fit. Cluster 1 was characterized by more severe stroke; cluster 2 by severe OSA and higher prevalence of medical comorbidities; cluster 3 by mild stroke and mild OSA; and cluster 4 by moderate OSA and mild stroke. Compared to cluster 3 and after adjustment for baseline stroke severity, cluster 1 and cluster 2 had worse 90-day functional outcome and cluster 1 also had worse quality of life. No difference in cognitive outcome or stroke recurrence rate was noted by cluster. Post-stroke OSA is a heterogeneous disorder with different clinical phenotypes associated with stroke outcomes, including both daily function and quality of life. The unique presentations of OSA after stroke may have important implications for stroke prognosis and personalized treatment strategies. •Patients with post-stroke obstructive sleep apnea are a heterogeneous group.•Among post-stroke patients with OSA, 90-day outcomes differed by phenotypic clusters.•The cluster with the most severe OSA was associated with worse functional outcome.