• Fawaz Al-Hussain and Yousef Mohammad.
• Department of Internal Medicine; College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Kingdom of Saudi Arabia. faalhussain@ksu.edu.sa.
• Neurol. Sci. 2020 Nov 1; 41 (11): 3301-3306.

BackgroundEach stroke subtype is associated with specific risk factors, and stroke prevention depends solely on the control of the underlying risk factors for each stroke subtype. Obstructive sleep apnea has been established as a major risk factor for stroke and cardiovascular disease. However, information on the stroke subtype linked to obstructive sleep apnea is scarce.MethodsThis was a single-center, observational case series study conducted on patients who were admitted with acute ischemic stroke to King Khalid University Hospital. The TOAST criteria were used to determine the stroke subtype in each of these patients. The Berlin questionnaire was utilized to assess the presence of obstructive sleep apnea. The proportion of each stroke subtype was then calculated and compared between the group with associated obstructive sleep apnea and the group without associated obstructive sleep apnea.ResultsA total of 170 consecutive patients with acute ischemic stroke were admitted between January 2018 and September 2018. Eighty-seven (51%) patients were found to have obstructive sleep apnea. The proportion of small artery disease was significantly greater in the obstructive sleep apnea group (44% vs. 26%, P = 0.02). There was no difference in the distribution of the other stroke subtypes between the two groups. Univariate analysis revealed that small artery disease was associated with body mass index, hypertension, and obstructive sleep apnea. However, in a multivariate logistic analysis, only hypertension was found to be independently associated with small artery disease.ConclusionSmall artery disease is the most common stroke subtype associated with obstructive sleep apnea. Clinicians must vigilantly assess the presence of obstructive sleep apnea in ischemic stroke patients, especially in patients whose stroke is attributed to small artery disease.

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