Obstructive risk apnoea implicated in intracerebral haemorrhage

Patients with obstructive sleep apnoea (OSA) are at heightened risk of developing intracerebral haemorrhage (ICH), a study has found.

The study used data from the Ethnic/Racial Variations of Intracerebral Hemorrhage, a multicentre, case-control study evaluating risk factors for ICH that included 3,000 patients with ICH and 3,000 non-ICH controls.

All participants completed the Berlin Questionnaire to ascertain OSA status as a surrogate for premorbid OSA. According to the results, there were 2,064 ICH patients (71 percent) and 1,516 controls (52 percent) classified as having OSA.

Compared with participants without OSA, those who had the condition were significantly more likely to be male and have hypertension, heart disease, hyperlipidaemia, and higher body mass index. Furthermore, OSA was detected with a greater frequency among ICH patients than among non-ICH controls (71 percent vs 52 percent; odds ratio [OR], 2.28, 95 percent confidence interval [CI], 2.05–2.55).

In a multivariable logistic regression model, OSA was associated with about a 1.5-fold higher likelihood of ICH (adjusted OR, 1.47, 95 percent CI, 1.29–1.67).

In a separate study, it was postulated that airway obstruction in patients with OSA-hypopnoea syndrome (HS) patients may affect the frontal gyrus, which controls pharyngeal muscle contraction to avoid active airway narrowing, and the overactivity and lower relative tolerance to hypoxic exposure and abnormal regulation of vascular endothelial function eventually leads to bleeding. This piece of information supports the reported link between OSA-HS and cognitive decline in patients with stroke. [Int J Clin Exp Med 2017;10:7137-7143]