AcuteCare Telemedicine Blog


Before Stroke Strikes

The fight against stroke, the second leading cause of death worldwide and leading cause of disability, begins long before a patient’s arrival to the ER. Awareness by physicians of common modifiable risk factors, including hypertension, diabetes and hyperlipidemia is key to the decrease the incidence of stroke. Obstructive sleep apnea (OSA), one such relatively common modifiable risk factor, is often unrecognized and underdiagnosed.

OSA is a disorder characterized by repetitive airway collapse, leading to arousals and oxygen distortions. It is well known that when these events occur, there is an increase in sympathetic tone and a rise in systemic blood pressure. OSA has also been found to be associated with an increase in proinflammatory and prothrombotic factors, both of which can lead to atherosclerosis and subsequent cardiovascular disease and stroke.

The results of the Sleep Heart Health Study, a 9 year prospective cohort study designed to determine risks associated with OSA, showed that OSA is an independent risk factor of stroke. It is estimated that over 15 million Americans have OSA, the majority of whom go undiagnosed.

Identifying patients at risk (i.e. those with obesity, loud snoring, excessive daytime sleepiness, etc.) should prompt consultation with a sleep disorders specialist. Appropriate work up and management should be implemented with an emphasis on treatment compliance. Public and professional awareness of the potential dangers of untreated OSA is crucial to a further decrease in stroke related morbidity and mortality.


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