Advertisement

Racial and ethnic differences in sleep-disordered breathing and sleep duration among stroke patients

      Abstract

      Objective

      We sought to characterize racial and ethnic differences in pre- and post-stroke sleep-disordered breathing (SDB) and pre-stroke sleep duration.

      Methods

      Within the Brain Attack Surveillance in Corpus Christi cohort of patients with ischemic stroke (8/26/2010-1/31/2020), pre-stroke SDB risk was assessed retrospectively using the Berlin Questionnaire. Post-stroke SDB was defined by prospective collection of the respiratory event index (REI) using the ApneaLink Plus performed shortly after stroke. Pre-stroke sleep duration was self-reported. We used separate regression models to evaluate the association between race/ethnicity and each outcome (pre-stroke SDB, post-stroke SDB, and pre-stroke sleep duration), without and with adjustment for potential confounders.

      Results

      There was no difference in pre-stroke risk of SDB between Black and non-Hispanic white (NHW) participants (odds ratio (OR) 1.07, 95% CI 0.77-1.49), whereas MA (Mexican American), compared to NHW, participants had a higher risk of SDB before adjusting for demographic and clinical variables (OR 1.26, 95% CI 1.08-1.47). Post-stroke SDB risk was higher in MA (estimate 1.16, 95% CI 1.06-1.28) but lower in Black (estimate 0.79, 95% CI 0.65-0.96) compared to NHW participants; although, only the ethnic difference remained after adjustment. MA and Black participants had shorter sleep duration than NHW participants (OR 0.83, 95% CI 0.72-0.96 for MA; OR 0.67, 95% CI 0.49-0.91 for Black participants) before but not after adjustment.

      Conclusions

      Racial/ethnic differences appear likely to exist in pre- and post-stroke SDB and pre-stroke sleep duration. Such differences might contribute to racial/ethnic disparities in stroke incidence and outcomes.

      Key Words

      Abbreviations:

      AHI (apnea-hypopnea index), BASIC (Brain Attack Surveillance in Corpus Christi), BMI (body mass index), MA (Mexican American), NIHSS (NIH stroke scale score), NHW (non-Hispanic White), REI (respiratory event index), SDB (sleep-disordered breathing), TIA (transient ischemic attack)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ge B
        • Guo X.
        Short and long sleep durations are both associated with increased risk of stroke: a meta-analysis of observational studies.
        Int J Stroke. 2015; 10: 177-184
        • Butler MJ
        • Spruill TM
        • Johnson DA
        • et al.
        Suboptimal sleep and incident cardiovascular disease among African Americans in the Jackson Heart Study (JHS).
        Sleep Med. 2020; 76: 89-97
        • Dong JY
        • Zhang YH
        • Qin LQ.
        Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies.
        Atherosclerosis. 2013; 229: 489-495
        • Howard G
        • Kissela BM
        • Kleindorfer DO
        • et al.
        Differences in the role of black race and stroke risk factors for first vs. recurrent stroke.
        Neurology. 2016; 86: 637-642
        • Morgenstern LB
        • Smith MA
        • Lisabeth LD
        • et al.
        Excess stroke in Mexican Americans compared with non-Hispanic Whites: the brain attack surveillance in corpus Christi project.
        Am J Epidemiol. 2004; 160: 376-383
        • Morgenstern LB
        • Smith MA
        • Sanchez BN
        • et al.
        Persistent ischemic stroke disparities despite declining incidence in Mexican Americans.
        Ann Neurol. 2013; 74: 778-785
        • Lisabeth LD
        • Sanchez BN
        • Lim D
        • et al.
        Sleep-disordered breathing and poststroke outcomes.
        Ann Neurol. 2019; 86: 241-250
        • Brown DL
        • Shafie-Khorassani F
        • Kim S
        • et al.
        Sleep-disordered breathing is associated with recurrent ischemic stroke.
        Stroke. 2019; 50: 571-576
        • Ramos AR
        • Guilliam D
        • Dib SI
        • et al.
        Race/ethnic differences in obstructive sleep apnea risk in patients with acute ischemic strokes in south Florida.
        Sleep Breath. 2014; 18: 165-168
        • De Lott LB
        • Lisabeth LD
        • Sanchez BN
        • et al.
        Prevalence of pre-stroke sleep apnea risk and short or long sleep duration in a bi-ethnic stroke population.
        Sleep Med. 2014; 15: 1582-1585
        • Lisabeth LD
        • Sanchez BN
        • Chervin RD
        • et al.
        High prevalence of poststroke sleep-disordered breathing in Mexican Americans.
        Sleep Med. 2017; 33: 97-102
        • Netzer NC
        • Stoohs RA
        • Netzer CM
        • et al.
        Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.
        Ann Intern Med. 1999; 131: 485-491
        • Ng SS
        • Chan TO
        • To KW
        • et al.
        Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome.
        Intern Med J. 2009; 39: 757-762
        • Ragette R
        • Wang Y
        • Weinreich G
        • et al.
        Diagnostic performance of single airflow channel recording (ApneaLink) in home diagnosis of sleep apnea.
        Sleep Breath. 2010; 14: 109-114
        • Chen H
        • Lowe AA
        • Bai Y
        • et al.
        Evaluation of a portable recording device (ApneaLink) for case selection of obstructive sleep apnea.
        Sleep Breath. 2009; 13: 213-219
        • Chan CH
        • Ng DK.
        Apnea-hypopnea index as the outcome variable in multiple linear regression analysis: statistical issues.
        Pediatr Pulmonol. 2007; 42: 711-715
        • Peduzzi P
        • Concato J
        • Kemper E
        • et al.
        A simulation study of the number of events per variable in logistic regression analysis.
        J Clin Epidemiol. 1996; 49: 1373-1379
        • Wang H
        • Cade BE
        • Sofer T
        • et al.
        Admixture mapping identifies novel loci for obstructive sleep apnea in Hispanic/Latino Americans.
        Hum Mol Genet. 2019; 28: 675-687
        • Brown DL
        • He K
        • Kim S
        • et al.
        Prediction of sleep-disordered breathing after stroke.
        Sleep Med. 2020; 75: 1-6
        • Ruiter ME
        • Decoster J
        • Jacobs L
        • et al.
        Normal sleep in African-Americans and Caucasian-Americans: a meta-analysis.
        Sleep Med. 2011; 12: 209-214
        • Carnethon MR
        • De Chavez PJ
        • Zee PC
        • et al.
        Disparities in sleep characteristics by race/ethnicity in a population-based sample: Chicago Area Sleep Study.
        Sleep Med. 2016; 18: 50-55
        • Petrov ME
        • Lichstein KL.
        Differences in sleep between black and white adults: an update and future directions.
        Sleep Med. 2016; 18: 74-81
        • Schutz SG
        • Lisabeth LD
        • Hsu CW
        • et al.
        Central sleep apnea is uncommon after stroke.
        Sleep Med. 2020;
        • Etindele Sosso FA
        • Matos E
        Socioeconomic disparities in obstructive sleep apnea: a systematic review of empirical research.
        Sleep Breath. 2021; 25: 1729-1739
        • Stulberg EL
        • Twardzik E
        • Kim S
        • et al.
        Association of neighborhood socioeconomic status with outcomes in patients surviving stroke.
        Neurology. 2021; 96: e2599-e2610