Obstructive sleep apnea (OSA) may represent a significant predictor of unfavorable outcomes in ruptured intracranial aneurysms, study findings published in the Journal of Clinical Sleep Medicine suggest.
The study was a retrospective review of clinical records of consecutive patients with ruptured intracranial aneurysm symptoms who presented to neurology and neurosurgery services at a university health sciences center in Louisiana (n=159). Computed tomography scans of the head and a 4-vessel angiogram or magnetic resonance angiogram helped to confirm a diagnosis of ruptured intracranial aneurysms in these patients. In addition, the STOP-BANG sleep questionnaire and polysomnography were used to identify patients with OSA. Preoperative clinical symptoms were assessed using the 5-point Hunt and Hess scale, and postoperative clinical outcomes were assessed with the 7-point Modified Rankin Scale.
The prevalence of OSA was approximately 5-fold higher in patients with ruptured intracranial aneurysms vs in patients without ruptured intracranial aneurysms (95% CI, 1.70-13.23; P =.002). In patients with ruptured intracranial aneurysms, the presence of OSA was significantly associated with a higher incidence of hypertension (OR, 4.90; 95% CI, 2.37-10.08; P <.0001), obesity (OR, 15.8; 95% CI, 7.81-31.73; P <.0001), hyperlipidemia (OR, 3.60; 95% CI, 1.71-7.74; P =.008), chronic heart disease (OR, 3.80; 95% CI, 1.63-8.99; P =.001), or prior ischemic stroke (OR, 5.80; 95% CI, 2.46-15.66; P <.0001) compared with in patients with ruptured intracranial aneurysms but without OSA.
In addition, the presence of OSA in patients with ruptured intracranial aneurysms was associated with a significantly higher number of wide-neck aneurysms (OR, 3.8; 95% CI, 2.09-6.09; P <.0001), aneurysms >7 mm (OR, 2.3; 95% CI, 1.33-4.14; P =.004), poor Hunt and Hess (grade 5; OR, 7.20; 95% CI, 1.60-68.08; P =.005), vasospasms (OR, 2.30; 95% CI, 1.16-4.83; P =.01), and poor Modified Rankin Scale scores (OR, 5.20; 95% CI, 2.34-11.59; P =.0002).
In the multivariate regression analysis, several variables were identified as positive predictors of unfavorable outcome of ruptured intracranial aneurysms, including the presence of hypertension (OR, 3.00; 95% CI, 1.05-14.00; P =.03), smoking (OR, 3.60; 95% CI, 1.22-10.57; P =.02), Hunt and Hess grade 4 to 5 (OR, 3.40; 95% CI, 1.08-10.99; P =.03), and OSA (OR, 2.50; 95% CI, 1.21-5.45; P =.007).
Limitations of the study included the retrospective nature, small number of cases with OSA, and reliance on data from a single institution.
According to the researchers, the “[s]creening of patients with [ruptured intracranial aneurysms] for initial diagnosis of OSA using the STOP-BANG questionnaire would be beneficial for this particular population.”
Chernyshev OY, Bir SC, Maiti TK, et al. The relationship between obstructive sleep apnea and ruptured intracranial aneurysms. J Clin Sleep Med. 2019;15(12):1839-1848.