Obstructive sleep apnea as a risk factor for silent cerebral infarction


Correspondence Chol Shin, MD, PhD, Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Institute of Human Genomic Study, Korea University Ansan Hospital, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, Korea. Tel.: +82-31-412-5603; fax: +82-31-412-5604; e-mail: chol-shin@korea.ac.kr


Previous studies have suggested that obstructive sleep apnea (OSA) may be a risk factor for stroke. In this study, we assessed that OSA is an independent risk factor of silent cerebral infarction (SCI) in the general population, and in a non-obese population. This study recruited a total of 746 participants (252 men and 494 women) aged 50–79 years as part of the Korean Genome and Epidemiology Study (KoGES); they underwent polysomnography, brain magnetic resonance imaging and health screening examinations. SCI was assessed by subtypes and brain regions, and lacunar infarction represented lesions <15 mm in size in the penetrating arteries. Moderate–severe OSA was determined by apnea–hypopnea index ≥15. The results indicated that 12.06% had moderate–severe OSA, 7.64% of participants had SCI and 4.96% had lacunar infarction. Moderate–severe OSA was associated positively with SCI [odds ratio (OR): 2.44, 95% confidence interval (CI): 1.03–5.80] and lacunar infarction (OR: 3.48, 95% CI: 1.31–9.23) in the age ≥65-year group compared with those with non-OSA. Additionally, in the basal ganglia, OSA was associated with an increase in the odds for SCI and lacunar infarction in all age groups, and especially in the ≥65-year age group. In the non-obese participants, OSA was also associated positively with SCI in the ≥65-year age group, lacunar infarction in all age groups, and especially in the ≥65-year age group. There was also a positive association with the basal ganglia. Moderate–severe OSA was associated positively with SCI and lacunar infarction in elderly participants. Treatment of OSA may reduce new first-time cerebrovascular events and recurrences.