Sleep Apnea, Diabetes, and Stroke

Patients suffering from sleep apnea have an increased risk of stroke.

  • Sleep apnea is a risk factor for stroke independent of other cardiovascular and cerebrovascular risk factors. Increased risk of stroke is observed even in cases of mild sleep apnea AHI [Rollover Text: Apnea-Hypopnea Index, the number of apneas and hypopneas per hour of sleep] less than 10 events/hr).1
  • The prevalence of sleep apnea in stroke patients has been shown in several studies to be greater than 60%.2,3,4
  • Multivariate analysis of 152 patients with acute ischemic stroke indicated that age, a history of diabetes, and night time onset of stroke were independent predictors of AHI.5
  • The odds ratio for prevalence of stroke in patients with AHI [Rollover Text: Apnea-Hypopnea Index, the number of apneas and hypopneas per hour of sleep] >20 events/hr, independent of obesity, is 3.8.6
  • Survival rates of stroke patients who have untreated sleep apnea are markedly worse than patients without sleep apnea.7

Stroke and heart disease account for 65% of deaths in patients with diabetes.

  • The risk of death from stroke is 2 to 4 times higher in patients with diabetes than in the general population after adjusting for age, cardiovascular risk factors, race and income.8,9,10
  • Elevated blood pressure is the major risk factor for stroke. The Third National Health and Nutrition Evaluation Survey showed that more than 70% of patients with type 2 diabetes are hypertensive.

Treatment of sleep apnea may reduce risk of stroke.

  • Effective treatment of sleep apnea with continuous positive airway pressure (CPAP) has been shown to lead to a significant reduction in diurnal and nocturnal blood pressure, which is the main risk factor for stroke.
  • CPAP treatment of sleep apnea has been shown to reduce the risk of new vascular events in stroke patients.11
  • Serum levels of soluble CD40 ligand, soluble P-selectin, and C-reactive protein, markers of elevated risk of future stroke, were decreased after 3 months of CPAP therapy for sleep apnea.12,13

Treatment of sleep apnea may help reduce blood pressure and systemic inflammation in patients with diabetes, thereby reducing their risk of stroke.

1 Shahar E et al. Am J Respir Crit Care Med 2001;163:19-25
2 Dyken ME et al. Stroke 1996;27:401-7
3 Bassetti CL et al. Neurology 1996;47:1167-73
4 Parra O et al. Am J Respir Crit Care Med 2000;161:375-80
5 Bassetti CL et al. Stroke 2006;37:967-72
6 Arzt M et al. Am J Respir Crit Care Med 2005;172:1447-51
7 Sahlin C et al. Arch Intern Med 2008;168:297-301
8 Stamler J et al. Diabetes Care 1993;16 :434-44
9 Mansen JE et al. Arch Intern Med 1991;151:1141-7
10 Kittner SJ et al. JAMA 1990;264 :1267-70
11 Martinez-Garcia MA et al. Chest 2005;128 :2123-9
12 Minoguchi K et al. Am J Respir Crit Care Med 2007;175:612-7
13 Yokoe T et al. Circulation 2003;107:1129-34