In a retrospective Italian study, one-half of patients with acute ischemic stroke also had obstructive sleep apnea (OSA) and another 28% had atrial fibrillation. These findings support the potential pathogenetic role of apnea-related hypoxia in ischemic stroke.

Risk assessment in patients with atrial fibrillation is important to reduce the risk of stroke. OSA is a well-established risk factor for both ischemic stroke and atrial fibrillation. The mechanisms linking OSA with ischemic stroke involve hemodynamic, neural, circadian, vascular, metabolic, inflammatory, and thrombotic processes.

The study conducted by Dr. Maria Rita Lo Monaco, and team sought to evaluate the prevalence of atrial fibrillation and OSA in participants with acute ischemic stroke within 7 days of onset.

The researchers collected data retrospectively from 146 participants over 4 years, encompassing clinical, neurologic, and cardiologic evaluations. Patient parameters were analyzed, including age, sex, BMI, wake-up stroke, National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), Groningen Upper Extremity Motor Score (GUSS), Apnea-Hypopnea Index (AHI), oxygen desaturation index (ODI), OSA severity, atrial fibrillation, and other cardiac risk factors.

In the participants with ischemic stroke, OSA prevalence was as high as 50%. The study further revealed that out of the 146 enrolled participants, 41 had documented episodes of atrial fibrillation. Notably, 22 participants were affected by both atrial fibrillation and OSA. This observed association was higher (15%) than expected only when considering each pathology separately (10%).

These results support the potential pathogenesis of apnea-related hypoxia, which poses a significant risk of ischemic stroke in patients with atrial fibrillation. The findings underscore the importance of considering the co-existence of atrial fibrillation and OSA in patients with stroke, as their association may indicate a pathogenic mechanism and influence treatment strategies to prevent stroke.

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