Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis

Chung-Yao Chen,1,2 Chia-Ling Chen3,4 1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan; 2School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital...

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Autores principales:	Chen CY, Chen CL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	obstructive sleep apnea ischemic stroke cluster analysis latent class analysis Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/f4ca06da2d82410eb975e92ec8f7f244
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spelling	oai:doaj.org-article:f4ca06da2d82410eb975e92ec8f7f2442021-12-02T14:32:47ZRecognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis1179-1608https://doaj.org/article/f4ca06da2d82410eb975e92ec8f7f2442021-03-01T00:00:00Zhttps://www.dovepress.com/recognizable-clinical-subtypes-of-obstructive-sleep-apnea-after-ischem-peer-reviewed-article-NSShttps://doaj.org/toc/1179-1608Chung-Yao Chen,1,2 Chia-Ling Chen3,4 1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan; 2School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; 4Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, TaiwanCorrespondence: Chung-Yao ChenDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, No. 200, Ln. 208, Jijin 1st Road, Anle Dist., Keelung City, 204, TaiwanTel +886-2-2432-9355 Ext 2545Fax +886-2-24315931Email jongyau2002@gmail.comBackground and Purpose: Obstructive sleep apnea (OSA) increases risk of stroke recurrence and mortality in ischemic stroke patients. However, equivocal treatment effects warrant further categorization of post-stroke OSA for risk stratification and individualized treatment planning.Methods: The study recruited 232 ischemic stroke patients with moderate-to-severe OSA admitted for inpatient rehabilitation consecutively. Latent class analysis was performed based on sex, age, smoking, daytime sleepiness, depression, obesity, sedative use, atrial fibrillation, diabetes, dyslipidemia, hypertension, recurrent stroke and dysphagia. The augmentation index, a marker of arterial stiffness, was measured by applanation tonometry.Results: A three-cluster model provided the best fit. Cluster 1 (n=84, 36.2%) was older in age, predominantly female, with the highest hypopnea index and prevalence of atrial fibrillation. Moreover, patients in Cluster 1 had significantly higher augmentation index than those in Cluster 2. Cluster 2 patients (N=80, 34.5%) were of older age, predominantly male, with the highest prevalence of depression, the lowest prevalence of hypertension and had the most normal body mass index (BMI). Additionally, Cluster 2 had less nocturnal hypoxia as compared to Cluster 3. Cluster 3 (n=68, 29.3%) was the youngest in age, predominantly male, with the highest BMI, cumulative risk score, and prevalence of dyslipidemia of the three clusters.Conclusion: Post-stroke OSA can be categorized into three clinical phenotypes. Patients in Clusters 1 and 3 both had elevated cardiovascular risk and treatment can be based on their distinct characteristics. Patients in Cluster 2 had relatively lower risk of cardiovascular events and the benefits of OSA treatment requires further study.Keywords: obstructive sleep apnea, ischemic stroke, cluster analysis, latent class analysisChen CYChen CLDove Medical Pressarticleobstructive sleep apneaischemic strokecluster analysislatent class analysisPsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol Volume 13, Pp 283-290 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	obstructive sleep apnea ischemic stroke cluster analysis latent class analysis Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	obstructive sleep apnea ischemic stroke cluster analysis latent class analysis Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 Chen CY Chen CL Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis
description	Chung-Yao Chen,1,2 Chia-Ling Chen3,4 1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan; 2School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; 4Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, TaiwanCorrespondence: Chung-Yao ChenDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, No. 200, Ln. 208, Jijin 1st Road, Anle Dist., Keelung City, 204, TaiwanTel +886-2-2432-9355 Ext 2545Fax +886-2-24315931Email jongyau2002@gmail.comBackground and Purpose: Obstructive sleep apnea (OSA) increases risk of stroke recurrence and mortality in ischemic stroke patients. However, equivocal treatment effects warrant further categorization of post-stroke OSA for risk stratification and individualized treatment planning.Methods: The study recruited 232 ischemic stroke patients with moderate-to-severe OSA admitted for inpatient rehabilitation consecutively. Latent class analysis was performed based on sex, age, smoking, daytime sleepiness, depression, obesity, sedative use, atrial fibrillation, diabetes, dyslipidemia, hypertension, recurrent stroke and dysphagia. The augmentation index, a marker of arterial stiffness, was measured by applanation tonometry.Results: A three-cluster model provided the best fit. Cluster 1 (n=84, 36.2%) was older in age, predominantly female, with the highest hypopnea index and prevalence of atrial fibrillation. Moreover, patients in Cluster 1 had significantly higher augmentation index than those in Cluster 2. Cluster 2 patients (N=80, 34.5%) were of older age, predominantly male, with the highest prevalence of depression, the lowest prevalence of hypertension and had the most normal body mass index (BMI). Additionally, Cluster 2 had less nocturnal hypoxia as compared to Cluster 3. Cluster 3 (n=68, 29.3%) was the youngest in age, predominantly male, with the highest BMI, cumulative risk score, and prevalence of dyslipidemia of the three clusters.Conclusion: Post-stroke OSA can be categorized into three clinical phenotypes. Patients in Clusters 1 and 3 both had elevated cardiovascular risk and treatment can be based on their distinct characteristics. Patients in Cluster 2 had relatively lower risk of cardiovascular events and the benefits of OSA treatment requires further study.Keywords: obstructive sleep apnea, ischemic stroke, cluster analysis, latent class analysis
format	article
author	Chen CY Chen CL
author_facet	Chen CY Chen CL
author_sort	Chen CY
title	Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis
title_short	Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis
title_full	Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis
title_fullStr	Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis
title_full_unstemmed	Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis
title_sort	recognizable clinical subtypes of obstructive sleep apnea after ischemic stroke: a cluster analysis
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/f4ca06da2d82410eb975e92ec8f7f244
work_keys_str_mv	AT chency recognizableclinicalsubtypesofobstructivesleepapneaafterischemicstrokeaclusteranalysis AT chencl recognizableclinicalsubtypesofobstructivesleepapneaafterischemicstrokeaclusteranalysis
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Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis

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