Sleep‐disordered breathing and poststroke outcomes
Open accessAbstract
Objective: To examine the association between sleep‐disordered breathing and stroke outcomes, and determine the contribution of sleep‐disordered breathing to outcome disparities in Mexican Americans. Methods: Ischemic stroke patients (n = 995), identified from the population‐based Brain Attack Surveillance in Corpus Christi Project (2010–2015), were offered participation in a sleep‐disordered breathing study including a home sleep apnea test (ApneaLink Plus). Sleep‐disordered breathing (respiratory event index ≥10) was determined soon after stroke. Neurologic, functional, cognitive, and quality of life outcomes were assessed at 90 days poststroke. Regression models were used to assess associations between sleep‐disordered breathing and outcomes, adjusted for sociodemographics, prestroke function and cognition, health‐risk behaviors, stroke severity, and vascular risk factors. Results: Median age was 67 years (interquartile range [IQR] = 59–78); 62.1% were Mexican American. Median respiratory event index was 14 (IQR = 6–25); 62.8% had sleep‐disordered breathing. Sleep‐disordered breathing was associated with worse functional outcome (mean difference in activities of daily living/instrumental activities of daily living score = 0.15, 95% confidence interval [CI] = 0.01–0.28) and cognitive outcome (mean difference in modified Mini‐Mental State Examination = −2.66, 95% CI = −4.85 to −0.47) but not neurologic or quality of life outcomes. Sleep‐disordered breathing accounted for 9 to 10% of ethnic differences in functional and cognitive outcome and was associated with cognitive outcome more strongly for Mexican Americans (β = −3.97, 95% CI = −6.63 to −1.31) than non‐Hispanic whites (β = −0.40, 95% CI = −4.18 to 3.39, p ‐interaction = 0.15). Interpretation: Sleep‐disordered breathing is associated with worse functional and cognitive function at 90 days poststroke. These outcomes are reasonable endpoints for future trials of sleep‐disordered breathing treatment in stroke. If effective, sleep‐disordered breathing treatment may somewhat lessen ethnic stroke outcome disparities. ANN NEUROL 2019;86:241–250
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Obstructive sleep apnea is an independent risk factor for incident stroke, stroke recurrence, mortality, and functional and cognitive outcomes.
“OSA is not only an independent risk factor for incident stroke 37 but also an independent risk factor for stroke recurrence, 38 mortality, and functional and cognitive outcomes.39”
From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [39]
The Results section (SDB and Ninety-day Stroke Outcomes; page unavailable) reports adjusted associations between sleep-disordered breathing and worse functional and cognitive outcomes 90 days after stroke. It does not establish an independent risk of mortality; the Study Participants section says patients who died before 90 days were excluded from the outcome analysis. The incident-stroke and recurrence claims have separate citations in the citing sentence. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Post-Stroke Fatigue: Epidemiology, Clinical Characteristics and Treatment
Acciarresi, M., Bogousslavsky, J., & Paciaroni, M. (2014) · European Neurology · doi:10.1159/000363763 · Cited by 1,423 · see citing works
Jorm, A. F., & Jacomb, P. A. (1989) · Psychological Medicine · doi:10.1017/s0033291700005742 · Cited by 1,104 · see citing works
Continuous positive airways pressure for obstructive sleep apnoea in adults
Giles, T., Lasserson, T., Smith, B., White, J., Wright, J., & Cates, C. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001106.pub2 · Cited by 1,001 · see citing works
Lackland, D. T., Roccella, E. J., Deutsch, A. F., Fornage, M., George, M. G., Howard, G., Kissela, B. M., Kittner, S. J., Lichtman, J. H., Lisabeth, L. D., et al. (2014) · Stroke · doi:10.1161/01.str.0000437068.30550.cf · Cited by 815 · see citing works
Self-citationFogel, S. M., & Smith, C. T. (2010) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2010.12.003 · Cited by 628 · see citing works
Baldwin, C. M., Griffith, K. A., Nieto, F. J., O’Connor, G. T., Walsleben, J. A., & Redline, S. S. (2001) · SLEEP · doi:10.1093/sleep/24.1.96 · Cited by 556 · see citing works
Accounting for Bias Due to Selective Attrition
Weuve, J., Tchetgen, E. J. T., Glymour, M. M., Beck, T. L., Aggarwal, N. T., Wilson, R. S., Evans, D. A., & de Leon, C. F. M. (2011) · Epidemiology · doi:10.1097/ede.0b013e318230e861 · Cited by 518 · see citing works
P value interpretations and considerations
Thiese, M. S., Ronna, B. B., & Ott, U. (2016) · Journal of Thoracic Disease · doi:10.21037/jtd.2016.08.16 · Cited by 502 · see citing works
The Familial Aggregation of Obstructive Sleep Apnea
Redline, S., Tishler, P. V., Tosteson, T. D., Williamson, J., Kump, K., Browner, I., Ferrette, V., & Krejci, P. (1995) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm/151.3_pt_1.682 · Cited by 473 · see citing works
Sleep-Disordered Breathing and Acute Ischemic Stroke
Bassetti, C. L., Миланова, М., & Gugger, M. (2006) · Stroke · doi:10.1161/01.str.0000208215.49243.c3 · Cited by 438 · see citing works
Sleep-Disordered Breathing and Poor Functional Outcome After Stroke
Good, D. C., Henkle, J. Q., Gelber, D. A., Welsh, J., & Verhulst, S. (1996) · Stroke · doi:10.1161/01.str.27.2.252 · Cited by 416 · see citing works
Continuous positive airways pressure for obstructive sleep apnoea in adults
Giles, T., Lasserson, T., Smith, B. J., White, J., Wright, J., & Cates, C. J. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001106.pub3 · Cited by 383 · see citing works
Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up.
Sahlin, C., Sandberg, O., Gustafson, Y., Bucht, G., Carlberg, B., Stenlund, H. C., & Franklin, K. A. (2008) · PubMed · doi:10.1001/archinternmed.2007.70 · Cited by 340 · see citing works
Relationship of Sleep Apnea to Functional Capacity and Length of Hospitalization Following Stroke
Kaneko, Y., Hajek, V. E., Zivanovic, V., Raboud, J., & Bradley, T. D. (2003) · SLEEP · doi:10.1093/sleep/26.3.293 · Cited by 281 · see citing works
Murphy, S. L., Xu, J., Kochanek, K. D., Curtin, S. C., & Arias, E. (2017) · PubMed · Cited by 277 · see citing works
Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial
Parra, O., Sánchez‐Armengol, Á., Bonnin, M., Arboix, A., Campos‐Rodríguez, F., Pérez‐Ronchel, J., Durán‐Cantolla, J., Torre, G. D. L., Marcos, J., de la Peña, M., et al. (2010) · European Respiratory Journal · doi:10.1183/09031936.00034410 · Cited by 246 · see citing works
Ryan, C. M., Bayley, M. T., Green, R., Murray, B. J., & Bradley, T. D. (2011) · Stroke · doi:10.1161/strokeaha.110.597468 · Cited by 223 · see citing works
Sandberg, O., Franklin, K. A., Bucht, G., Eriksson, S., & Gustafson, Y. (2001) · European Respiratory Journal · doi:10.1183/09031936.01.00070301 · Cited by 216 · see citing works
Hsu, C.-Y. (2006) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2005.086686 · Cited by 202 · see citing works
Diagnostic Criteria and Quality Control of the Registration of Stroke Events in the MONICA Project
Asplund, K., Tuomilehto, J., Stegmayr, B. G., Wester, P. O., & Tunstall‐Pedoe, H. (1988) · Acta Medica Scandinavica · doi:10.1111/j.0954-6820.1988.tb05550.x · Cited by 197 · see citing works
The Impact of Obesity on Oxygen Desaturation during Sleep-disordered Breathing
Peppard, P. E., Ward, N. R., & Morrell, M. J. (2009) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200905-0773oc · Cited by 194 · see citing works
Effect of upper airway obstruction in acute stroke on functional outcome at 6 months
Turkington, P. M. (2004) · Thorax · doi:10.1136/thx.2003.005348 · Cited by 177 · see citing works
Bravata, D. M., Concato, J., Fried, T. R., Ranjbar, N. E., Sadarangani, T., McClain, V., Struve, F. A., Zygmunt, L., Knight, H. J., Lo, A., et al. (2011) · SLEEP · doi:10.5665/sleep.1254 · Cited by 164 · see citing works
Population shifts and the future of stroke: forecasts of the future burden of stroke
Howard, G., & Goff, D. C. (2012) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2012.06665.x · Cited by 163 · see citing works
Persistent ischemic stroke disparities despite declining incidence in Mexican Americans
Morgenstern, L. B., Smith, M. A., Sánchez, B. N., Brown, D. L., Zahuranec, D. B., Garcia, N. M., Kerber, K. A., Skolarus, L. E., Meurer, W. J., Burke, J. F., et al. (2013) · Annals of Neurology · doi:10.1002/ana.23972 · Cited by 159 · see citing works
Self-citationBland, R. C., & Newman, S. C. (2001) · The Canadian Journal of Psychiatry · doi:10.1177/070674370104600604 · Cited by 156 · see citing works
Sleep Apnea, Delirium, Depressed Mood, Cognition, and ADL Ability After Stroke
Sandberg, O., Franklin, K. A., Bucht, G., & Gustafson, Y. (2001) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2001.49081.x · Cited by 152 · see citing works
Patient-Reported Outcome Measures (PROMs) for Acute Stroke: Rationale, Methods and Future Directions
Reeves, M., Lisabeth, L., Williams, L., Katzan, I., Kapral, M., Deutsch, A., & Prvu-Bettger, J. (2018) · Stroke · doi:10.1161/strokeaha.117.018912 · Cited by 147 · see citing works
Self-citationNg, S. S. S., Chan, T. ‐., To, K., Ngai, J. C. L., Tung, A., Ko, F. W. S., & Hui, D. S. C. (2008) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2008.01827.x · Cited by 145 · see citing works
Obstructive Sleep Apnea is Related to Impaired Cognitive and Functional Status after Stroke
Aaronson, J. A., van Bennekom, C. A. M., Hofman, W. F., van Bezeij, T., van den Aardweg, J. G., Groet, E., Kylstra, W. A., & Schmand, B. A. (2015) · SLEEP · doi:10.5665/sleep.4984 · Cited by 119 · see citing works
Aaronson, J. A., Hofman, W. F., van Bennekom, C. A. M., van Bezeij, T., van den Aardweg, J. G., Groet, E., Kylstra, W. A., & Schmand, B. A. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.5684 · Cited by 109 · see citing works
Neurological, Functional, and Cognitive Stroke Outcomes in Mexican Americans
Lisabeth, L. D., Sánchez, B. N., Baek, J., Skolarus, L. E., Smith, M. A., Garcia, N. M., Brown, D. L., & Morgenstern, L. B. (2014) · Stroke · doi:10.1161/strokeaha.113.003912 · Cited by 106 · see citing works
Self-citationBirkbak, J., Clark, A. J., & Rod, N. H. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3376 · Cited by 103 · see citing works
Continuous Positive Airway Pressure Ventilation for Acute Ischemic Stroke
Minnerup, J., Ritter, M., Wersching, H., Kemmling, A., Okegwo, A., Schmidt, A., Schilling, M., Ringelstein, E. B., Schabitz, W. R., Young, P., et al. (2011) · Stroke · doi:10.1161/strokeaha.111.637611 · Cited by 86 · see citing works
Sleep Architecture in Stroke and Relation to Outcome
Terzoudi, A., Vorvolakos, T., Heliopoulos, I., et al. (2008) · European Neurology · doi:10.1159/000165344 · Cited by 83 · see citing works
Gupta, A., Shukla, G., Afsar, M., Poornima, S., Pandey, R. M., Goyal, V., Srivastava, A. K., Vibha, D., & Behari, M. (2018) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7034 · Cited by 80 · see citing works
Sleep apnea screening is uncommon after stroke
Brown, D. L., Jiang, X., Li, C., Case, E. C., Sozener, C. B., Chervin, R. D., & Lisabeth, L. D. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.09.009 · Cited by 75 · see citing works
Self-citationDiagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease
Bravata, D. M., Sico, J. J., Fragoso, C. A. V., Miech, E. J., Matthias, M. S., Lampert, R. J., Williams, L. S., Concato, J., Ivan, C. S., Fleck, J. D., et al. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.008841 · Cited by 66 · see citing works
Correlation between sleep and cognitive functions after hemispheric ischaemic stroke
Siccoli, M. M., Rölli‐Baumeler, N., Achermann, P., & Bassetti, C. L. (2008) · European Journal of Neurology · doi:10.1111/j.1468-1331.2008.02119.x · Cited by 60 · see citing works
Menon, D., Sukumaran, S., Varma, R. P., & Radhakrishnan, A. (2017) · Acta Neurologica Scandinavica · doi:10.1111/ane.12740 · Cited by 52 · see citing works
Saletu, M. T., Kotzian, S. T., Schwarzinger, A., Haider, S., Spatt, J., & Saletu, B. (2018) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7322 · Cited by 48 · see citing works
Khot, S. P., Davis, A. P., Crane, D. A., Tanzi, P. M., Li Lue, D., Claflin, E. S., Becker, K. J., Longstreth, W. T., Watson, N. F., & Billings, M. E. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.5940 · Cited by 41 · see citing works
Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients
Zhang, Y., Wang, W., Cai, S., Sheng, Q., Pan, S., Shen, F., Tang, Q., & Liu, Y. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2016.11.028 · Cited by 35 · see citing works
Sleep-disordered breathing among acute ischemic stroke patients in Brazil
Camilo, M. R., Schnitman, S. V., Sander, H. H., Éckeli, Á. L., Fernandes, R. M. F., Leite, J. P., Bassetti, C. L., & Pontes‐Neto, O. M. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.11.008 · Cited by 34 · see citing works
High prevalence of poststroke sleep-disordered breathing in Mexican Americans
Lisabeth, L. D., Sánchez, B. N., Chervin, R. D., Morgenstern, L. B., Zahuranec, D. B., Tower, S. D., & Brown, D. L. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.01.010 · Cited by 31 · see citing works
Self-citationSpontaneous improvement in both obstructive sleep apnea and cognitive impairment after stroke
Slonková, J., Bar, M., Nilius, P., Beránková, D., Šalounová, D., & Šonka, K. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2016.11.024 · Cited by 30 · see citing works
Cavalcanti, P., Campos, T. F., & Araújo, J. F. (2013) · Neurorehabilitation · doi:10.3233/nre-130853 · Cited by 29 · see citing works
Validation of the 12-Item Stroke-Specific Quality of Life Scale in a Biethnic Stroke Population
Kerber, K. A., Brown, D. L., Skolarus, L. E., Morgenstern, L. B., Smith, M. A., Garcia, N. M., & Lisabeth, L. D. (2012) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2012.08.011 · Cited by 28 · see citing works
Self-citationSaetung, S., Nimitphong, H., Siwasaranond, N., Sumritsopak, R., Jindahra, P., Krairit, O., Thakkinstian, A., Anothaisintawee, T., & Reutrakul, S. (2018) · Acta Diabetologica · doi:10.1007/s00592-018-1166-3 · Cited by 28 · see citing works
Is Technologist Review of Raw Data Necessary after Home Studies for Sleep Apnea?
Brown, D. L., Chervin, R. D., Hegeman, G. L., et al. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3606 · Cited by 18 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Yeghiazarians, Y., Jneid, H., Tietjens, J. R., Redline, S., Brown, D. L., El-Sherif, N., Mehra, R., Bozkurt, B., Ndumele, C. E., Somers, V. K., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000988 · Cited by 1,431 · see citing works
Self-citation
- Authors
- Lisabeth, L. D., Sánchez, B. N., Lim, D., Chervin, R. D., Case, E., Morgenstern, L. B., Tower, S., & Brown, D. L.
- Affiliations
- University of Michigan (US)
- Michigan Medicine (US)
- local physician Corpus Christi TX
- Corresponding author
- Lisabeth, Lynda D.
- ORCID
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2019-06-19
- Volume
- 86
- Issue
- 2
- Pages
- 241-250
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- PMC
- PMC7549189
- OpenAlex
- W2948206285
- Cited by
- 71
- References
- 50
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 8 · 2023: 16 · 2022: 17 · 2021: 7 · 2020: 2 · 2019: 2
- FWCI
- 4.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (R01 NS070941, R01 NS38916)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- sleep-disordered breathing, obstructive sleep apnea, ischemic stroke, functional outcome, cognitive outcomes, Mexican Americans, ethnic disparities, home sleep apnea testing, activities of daily living, quality of life
- MeSH terms
- Activities of Daily Living, Aged, Female, Humans, Male, Middle Aged, Sleep Apnea Syndromes, Treatment Outcome, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
