Comorbid sleep-disordered breathing and AF poststroke linked to elevated mortality, recurrence

Stroke patients with comorbid moderate-to-severe sleep-disordered breathing (SDB) and atrial fibrillation (AF) are at heightened risk of long-term mortality or recurrent cerebro-cardiovascular events, according to a study.

The study included 353 patients (median age 67 years, 63 percent men) with acute ischaemic stroke (n=299) or transient ischaemic attacks (n=54). SDB was assessed using respiratory polygraphy during acute hospitalization, whereas AF was screened using a 7-day ECG up to three times in the first 6 months. The patients attended follow-up visits at 1, 3, 12, 24, and 36 months poststroke.

Of the patients, 118 had moderate-to-severe SDB (apnoea-hypopnea index score ≥15/h) and 56 had AF, among whom 28 had comorbid moderate-to-severe SDB. A total of 12 deaths and 67 recurrent cerebro-cardiovascular events were documented over 36 months.

Multivariable Cox regression models showed that the risk of subsequent death or cerebro-cardiovascular events was twofold higher among patients with comorbid moderate-to-severe SDB and AF than among those with only moderate-to-severe SDB without AF (hazard ratio [HR], 2.49; 95 percent confidence interval [CI], 1.18–5.24) and those without moderate-to-severe SDB or AF (HR, 2.25; 95 percent CI, 1.12–4.50).

The risk did not differ between patients with comorbid moderate-to-severe SDB and AF group and those who had AF only (HR, 1.64; 95 percent CI, 0.62–4.36).