Abstract Details

Title Severity of Obstructive Sleep Apnea and Burden of Cerebral Microbleeds in Patients with Atrial Fibrillation

Topic Sleep

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-030

Objective To study the effect of obstructive sleep apnea (OSA) severity on the burden of cerebral microbleeds (CMBs) in patients with atrial fibrillation (AF)

Background

About one in three patients with AF have concurrent OSA. Both AF and OSA increase the risk of CMBs; however, the relationship between severity of OSA and burden of CMBs is unknown. We retrospectively studied patients with AF, CMBs, and OSA to evaluate the association between OSA severity and CMB burden.

Design/Methods All patients aged ≥18 with documented AF, with ≥1 CMB detected on brain MRI were identified through an institutional database from 2015 to 2018. Individual brain MRIs were read and patients with CMB mimics were excluded. Within this cohort, all patients diagnosed with OSA from polysomnography (PSG) reports were included and reviewed for PSG indices: apnea-hypopnea index (AHI), arousal index, periodic limb movements (PLM), oxygen nadir, and Epworth Sleepiness Scale (ESS). The association between PSG indices and CMBs were assessed by univariate and multivariable logistic regression using SPSS v22. All tests were performed at the 0.05 level.

Results

Of the 312 patients with concurrent AF and CMB, 28%(87/312) had a PSG study (age, 76±8 years; female, 25.3%[22/87]). The mean AHI was 24.2±20.2. There was a significant association between moderate-severe OSA (AHI>15) and number of CMBs overall (RR 3.4, 95%CI 2.0-4.79, p<0.001), lobar CMBs (RR 2.65, 95%CI 1.6-3.6, p<0.001), and deep CMBs (RR 0.58, 95%CI 0.11-1.04, p=0.014) on univariate analysis. This association lost significance when adjusting for age and body mass index (mean, 29.8±5.7 kg/m²). There was no significant relationship between CMB burden and other PSG indices.

Conclusions

Although AHI was not found to be an independent risk factor for CMBs, it may be reasonable for patients with moderate-severe OSA and AF to be screened for CMBs as the risk of high CMB burden may alter antithrombotic treatment decisions.

Authors/Disclosures
George K. Vilanilam, MBBS PRESENTER	Dr. Vilanilam has nothing to disclose.
	No disclosure on file
Eric Goldstein, MD (Brown University Warren Alpert School of Medicine)	Dr. Goldstein has nothing to disclose.
	No disclosure on file
Kevin M. Barrett, MD, FAAN (Mayo Clinic)	Dr. Barrett has nothing to disclose.
Thomas G. Brott, MD, FAAN (Mayo Clinic)	Dr. Brott has nothing to disclose.
James F. Meschia, MD, FAAN (Mayo Clinic)	The institution of Dr. Meschia has received research support from NINDS. The institution of Dr. Meschia has received research support from NINDS.
Brynn K. Dredla, MD (Mayo Clinic)	The institution of Dr. Dredla has received research support from NIH.

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