High prevalence of poststroke sleep-disordered breathing in Mexican Americans

Abstract

Objective The purpose of this study is to compare sleep-disordered breathing (SDB) prevalence and severity after stroke between Mexican Americans (MAs) and non-Hispanic whites (NHWs). Patients/methods Ischemic stroke (IS) patients within ~30 days of onset were identified from the population-based BASIC Project (2010–2014) and offered screening with an overnight cardiopulmonary monitoring device, ApneaLink Plus™. The number of apneas and hypopneas per hour, as reflected by the apnea/hypopnea index (AHI), was used to measure SDB severity; SDB was defined as AHI ≥10. Ethnicity, demographics, and risk factors were collected from interviews and medical records. Log and negative-binomial regression models were used to determine prevalence ratios (PRs) and apnea/hypopnea event rate ratios (RRs) comparing MAs with NHWs after adjustment for demographics, risk factors, and stroke severity. Results A total of 549 IS cases had AHI data. The median age was 65 years (interquartile range (IQR): 57–76), 55% were men, and 65% were MA. The MAs had a higher prevalence of SDB (68.5%) than NHWs (49.5%) in unadjusted (PR = 1.38; 95% confidence interval (CI): 1.14–1.67) and adjusted analyses (PR = 1.21; 95% CI: 1.01–1.46). The median AHI was 16 (IQR: 7–31) in MAs and nine (IQR: 5–24) in NHWs. The severity of SDB (rate of apneas/hypopneas) was higher in MAs than NHWs in unadjusted (RR = 1.31; 95% CI: 1.09–1.58) but not adjusted analysis (RR = 1.14; 95% CI: 0.95–1.38). There was no ethnic difference in severity among subjects with SDB. Conclusion More than two-thirds of MA stroke patients had SDB, which was almost 40% more common among MAs than NHWs. Physicians treating MA patients after stroke should have a high index of suspicion for SDB, a treatable condition that could otherwise have adverse impact.