Abstract

Introduction: Obstructive-sleep apnea (OSA) is a treatable breathing disorder that has been shown to be highly prevalent among adults with stroke. The objective of our current study was to assess the prevalence of OSA in children with arterial ischemic stroke (AIS).

Methods:  A consecutive cohort of children with AIS and clinically indicated polysomnography (PSG) attending the Stroke Clinic from 2001-2015 were retrospectively evaluated. PSG studies of control no-AIS patients were also evaluated. OSA was defined as obstructive apnea hypopnea index (OAHI)≥1.5.

Results: Twenty-three children with AIS (mean age±SD: 7.7±4.8 years, 47.8% females) and 8 no-AIS patients (mean age±SD: 10.5±3.3 years, 75% females) were included. OSA was significantly more common in children with AIS (69% vs. 25%, p=0.0429) regardless of the timing of sleep study (73.3% OSA post-stroke and 62.5% OSA pre-stroke diagnosis). AIS patients had significantly lower minimum SaO₂ values overnight (83.2% vs. 94.6%, p=0.0072), and comparable overnight mean end tidal (et) and transcutaneous (tc) CO₂ levels (et CO₂: 42.8 vs. 41.8 mmHg, p=0.4940; tc CO₂: 42.08 vs. 39.67 mmHg, p=0.3544, respectively). Stroke sub-types included: 3 moyamoya (33% with OSA), 8 cardiac (63% with OSA) and 5 SCD (83% with OSA). Cardiac patients had the lowest nocturnal SaO₂ and highest CO₂ levels.

Conclusions: Children with AIS were more likely to have OSA and associated nocturnal hypoxemia, highlighting these as potential risk factors for stroke in childhood. Future prospective studies are required to further explore the relationship between OSA, hypoxemia and stroke in childhood.