Sleep Apnea May Be Tied to 'Silent' Strokes, Study Finds

WEDNESDAY, Feb. 1 (HealthDay News) -- Sleep apnea, the disorder marked by abnormal pauses in breathing during sleep, is already known to boost the risk of stroke. Now, a new study links sleep apnea to so-called silent strokes, in which there is tissue death in the brain without symptoms.

In another new study, researchers found that rapid memory loss before a stroke boosts the risk of the stroke being fatal.

Both studies are slated for presentation Wednesday at the American Stroke Association's International Stroke Conference in New Orleans.

Stroke affects 795,000 Americans annually, according to the association.

In one study, Dr. Jessica Kepplinger, a fellow at the University of Technology in Dresden, Germany, and her colleagues evaluated 56 patients who had a stroke. They knew that silent strokes had been linked to an increased risk of strokes. However, "there are barely any studies that have investigated the relationship between sleep apnea and the so-called clinically silent strokes," she said.

To look at the relationship, they first gave patients in-hospital testing for apnea. "We found an overall high frequency of sleep apnea, 91 percent, in our study population of acute stroke patients, which underlines the importance of this stroke risk factor," Kepplinger said.

The team also performed brain-imaging studies. Those with sleep apnea were more likely to have the silent strokes, as evidenced on the brain scans, the researchers found. Having more than five episodes a night was linked with having silent strokes. The higher the severity of the apnea, the more likely these silent strokes were found on brain imaging.

The more severe the apnea, the less favorable the outcome when the patient was discharged.

The patients were on average 67 years old, and just over half of them were women, the study authors noted.

While the study found an association between sleep apnea and stroke, it did not prove a cause-and-effect relationship.

In the second study, Qianyi Wang, a graduate student at the Harvard University School of Public Health, and colleagues evaluated nearly 12,000 men and women, all above age 50, enrolled in the U.S. Health and Retirement Study.

All were stroke-free at the start. The men and women were given memory tests every two years for up to 10 years.

Over time, 1,820 strokes were reported, including 364 people who died after the stroke.

The others were stroke-free for the entire follow-up period, the study authors noted.

The research looked at the memory declines over time. Those who later survived a stroke "had memory decline that is nearly twice as fast as stroke-free individuals, even before their stroke," Wang said.

"For people who do not survive stroke, this difference is even more striking," said M. Maria Glymour, an assistant professor of society, human development and health at Harvard and a study co-author. "Prior to stroke, people who later died shortly after stroke were declining three times as fast as the stroke-free."

The study was funded by the U.S. National Institute on Aging and the American Heart Association.

"Our study is the first national picture of how memory changes over the long-term before and after stroke onset, compared to individuals who do not have a stroke," Glymour said.

Both studies provide some valuable information, said Dr. Ralph Sacco, chair of neurology at the University of Miami Miller School of Medicine and past president of the American Heart Association. He reviewed the findings.

"It's been mainly in smaller studies that sleep apnea has been shown to be a risk factor for stroke," Sacco said. The new research, he noted, goes even further by linking sleep apnea with the milder "silent" strokes.

"There are many reasons to treat sleep apnea, including reducing the risk for clinical and now silent stroke," Sacco said.

The memory-loss study, he said, "is telling us that those who have the worst memory loss may have a greater death rate when they have the stroke." Those with more memory loss in the study may also have had more risk factors for stroke, Sacco added.

Even so, he said, the message seems to be that taking care of brain health may help us in several ways. "What is good for our memory may also be good for surviving a stroke," Sacco said.

Because these studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

Visit the American Stroke Association to learn more about stroke.

 
  • Jackie  •  Oshkosh, Wisconsin  •  3 months ago
    I was diagnosed with sleep apnea 11 years ago and given a CPAP machine. I used it for awhile and then less and less until not at all. I then suffered a ruptured brain aneurysm while driving to work one day. I am VERY grateful to be alive since the odds were against me. Since then I had another sleep study and got a newer, quieter machine and a better mask and I won't even take a short nap without it on.
    • Susan R 3 months ago
      So glad you survived! I never wore my CPAP because I couldn't tolerate it. I'm glad for all the comments here, as soon as my Medicare kicks in, if I survive that long, I'll get another machine and use it. (Disability - Medicare doesn't take effect for two years-we need new legislation.)
  • Guy  •  3 months ago
    And by the way, to all the other idiots who think sleep apnea is a problem only for the overweight- WRONG! The tongue, nasal and throat structure can cause obstructions too.
  • MICHAEL  •  Bolingbrook, Illinois  •  3 months ago
    I used to ignore my wife's complaints about my excessive snoring. What would a nurse know about a health problem - Duh. I finally went for a sleep study and was diagnosed with sleep apnea. I've been using a CPAP machine for ten years or so and stopped all the snoring. I didn't know just how tired I was all the time until I finally sleep all the way through the night.
    • andykkk 3 months ago
      Are you serious...that machine is in my garage for over a year now collecting dust can you instruct me on how to use the darn thing!!..I want restful sleep!!
    • Tesla Kuhn 3 months ago
      you put it on and push the button. make sure it's plugged in. kidding aside, it does take getting used to, what helped me is I was thinking of that scene from "the Abyss" where they are instructing dude to breathe the fluid. I have no idea why that helped me. I also have experience with breathing exercises so it was mind over matter. anyway it does cause some inflammation of the sinuses if you don't use the humidifier settings (if yours came with one). people were messing with me telling me I was the blonde who needed a recording to tell me when to breathe. I was like, totally offended.
    • Joe 3 months ago
      The main reasons people don't use their machines:
      1. It wasn't fitted correctly.
      2. They don't know there are different masks to choose from, and some might feel better for different people.
      3. The settings aren't right for them (too much or too little pressure).
      4. They didn't take enough time to get used to it.
      5. They don't use the "ramp" feature, where the pressure increases gradually as you fall asleep, which makes the process less disturbing.

      For my part, once I became accustomed to the equipment, if found it uncomfortable to sleep without it.
  • grasence  •  3 months ago
    A family member, now deceased, had sleep apnea. It is kind of frightening to watch someone take a nap and just see them stop breathing. In this case, it was about 20-30 seconds and then she would awaken as she tried to breathe again. If you do not have apnea, try to imagine waking up 100's, maybe more, times a night and/or during naps. You are never rested, always have low energy and lack of the ability to lead an active life. It becomes a vicious cycle that never resolves itself until treatment. In this case, this elderly family member also had a history of larger and smaller strokes.
    • Phoenix 3 months ago
      They have linked the Pulmonary Embolism that killed my mother instantly to her sleep apnea. I have bpap of 85 myself. This means i stop breathing or my breathing becomes extremely shallow 85 times an hour. before being diagnosed i could not sleep at all hardly. Now i still do not sleep great due to stress factors in life but i can at least sleep now. My first reading of my machine showed me going from a bpap of 85 to 0 in just that short of a time frame.
  • Benn Gleck  •  3 months ago
    I hated my cpap machine and rarely used it for the first 4 years. Now I can't imagine a night without it. I've had sleep apnea for at least 20 years and I'm not fat. Although when I've gained 10 lbs it tends to get even worse. I've had my uvula removed, and nasal turbinates reduced twice. This condition does not only affect fat people. At this point, I have high BP and some days I feel like I'm going to keel over from a heart attack, so my suggestion to anyone diagnosed with this condition is WEAR YOUR CPAP and try to live life to the fullest because you're probably not going to live as long as you thought.
    • Mike N 3 months ago
      blood pressure is the cause of the apnea
    • Dorothy Murray- Foust 3 months ago
      I have had my cpap machine for over a year, I have been 99.9% compliant, I can not use the alrger face mask so if anyoen has a problem with that get the one that just goes into the nose, better to use the CPAP machine than being dead
    • Cubs 3 months ago
      All God's chillun have a uvula. Except Benn Gleck.
  • God not applicable  •  3 months ago
    I have tried the CPAP machine and I cannot fall asleep wearing that mask over my face.. I do not understand why the medical insurance companies are not willing to cover an operation to reduce sleep apnea.
  • Bernie  •  3 months ago
    I suffered with OSA for probably more than a decade before I was diagnosed with this sneaky condition by an insightful ENT doctor who treated me by removing my tonsils. It is time for doctors and the medical community in general to start screening for and treating this condition for the public health threat that it is. It is almost unquestionable that deaths of people such as NFL great Reggie White, Actor Heath Ledger, and singer Gerald Levert are tied to this condition. I can testify myself to that nature of the health risk with this condition as it causes a loss of productivity, a general decline in the ability to think, reason, process, extreme tiredness and a significant loss of quality of life. OSA brings an increased risk to the person, and public safety due to a sleep deprivation and exhaustion. I fell asleep at the wheel in front of a traffic light one day and I had no clue that that was about to happen. When I woke, up cars were whizzing by me. I am convinced that people die in their sleep all the time and run into other cars(people) killing themselve and or others due to this condition.
  • Firebrand  •  3 months ago
    I was just diagnosed with sleep apnea 6 months ago. I wish they would have reported if using the CPAP machine reduced the stroke risk or not.
  • Rosa  •  Chicago, Illinois  •  3 months ago
    Ignorance again,surprise surprise. Not all people with sleep apnea are overweight.
    "You are at a higher risk if you are:
    Male
    Related to someone who has sleep apnea
    Over the age of 65
    Black, Hispanic, or a Pacific Islander
    A smoker

    Other risk factors for obstructive sleep apnea include certain physical attributes, such as having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids (the most common cause of sleep apnea in children). Your airway may be blocked or narrowed during sleep simply because your throat muscles tend to relax more than normal. Allergies or other medical conditions that cause to nasal congestion and blockage can also contribute to sleep apnea."
    Do you not know how to use a search engine?
  • Donald  •  3 months ago
    This is a very serious illness and should be diagnosed as quickly as possible. God bless you if you have any of the symptoms and for God sake, go get a sleep study. I drive on the same roads as you do and I prefer you to stay awake while I'm driving! Believe me, I know all about this disease because my wife has severe sleep apnea and has used a C-PAP for years which is proof it doesn't just happen to overweight people. They make so many different kinds of masks, most folks find a comfortable fit pretty quickly. Being overweight can aggravate the condition but it tends to run in families. Everyone in her family has stroked out even as early as in the early thirties. She swears her Dad snored so bad, he would wake himself up, another sign of the disease. I think everyone in her family could have benefited from a sleep study and treatment but sadly, they just started treating it seriously not too long ago.
  • A Yahoo! User  •  3 months ago
    Cessation of breathing is a killer and that's really all that sleep apnea is so of course you can expect strokes and heart problems. My CPAP helps me sleep through the night, but it exacerbates sinus inflammation. The ringing noise in my head is horrendous in a quiet environment.

    A benefit of treatment is that since sleep apnea causes fat retention -- Not enough sleep = weight gain -- you can expect to lose weight slowly as you use your CPAP machine.
  • Karen Michele  •  3 months ago
    Wow - some of these comments simply verify the lack of education of a very serious and under-diagnosed condition. At age 46 I am now on full SSDI because of a combination of conditions all related to sleep apnea. I am not overweight, in fact in very good shape up to my mid-30's. Yes, as I got older my metabolism has changed and my weight has fluctuated but I have never been considered obese. I suspect I have had the condition since my late teens, early 20s which explains why I always felt like I was draggin myself through each day. I could nap anytime, anywhere. I just figured I wasn't a "morning person" as I often overslept, ran late, had minor mishaps...I could go on. In my case, my involuntary reaction which would normally keep my airway open is "off." My muscles relax so much that the airway simply collapses. I also had a deviated septum which was corrected before the sleep test. You try and stop breathing 40 times per minute and tell me how you feel...I bet you can't even do it. However, that is how I spent most of my life - low oxygen levels in the blood affecting the brain, major organs, resulted in high blood pressure in my early 20's, anxiety, thyroid....I have only been diagnosed just under 3 years now and it seems every week I learn something new.....it is a very serious condition and some of these comments are a clear indication of lack of education, understanding, misinformation and ignorance of a very serious medical condition in which undiagnosed results in early death.
  • Lynne D. Thomas, DDS  •  3 months ago
    Also diabetes, high blood pressure, weight gain and inability to lose weight among other diseases have been linked to Obstructive Sleep Apnea;
  • David A  •  Encino, California  •  3 months ago
    Apnea-Cessation of breathing causes CO2 buildup in bloodstream and Oxygen saturation
    in blood to drop!! The heart speeds up as a shock from the snore/gasp ending!
    This can happen 600 times per night- every night and the person never gets into deep
    sleep and is tired no matter how much sleep the person gets!! Snoring is a sign of
    Obstructive Apnea or Mixed Apnea. If you snore lie on your side-not on your back!!
    Alcohol makes Apnea 4 times worse!! Tell Your Physician regarding tiredness
    snoring-morning headaches -Mental Fragmentation-impotency ETC!! GET TREATMENT!!
  • DSD  •  3 months ago
    I wonder how many were in excellent physical condition that experienced "silent strokes" or memory loss. At 47 I have sleep APNEA and am about 25 pounds overweight 5' 9" @198 and am striving to loose that asap. Its not hard to work out, its harder to change eating habits and proper intake. Lower sodium, low fat, low cholesterol, and small portions is going to be difficult but it better than the alternative.
  • Phil  •  3 months ago
    The article missed treatment for Sleep Apnea, as well as informing readers that there are two types of sleep apnea, Central and Obstructive, and you could also have Complex, which is a combination of both. Central is caused by the brain not signaling to breath, sometimes caused by a head injury, and obstructive is the blockage of the airway in the throat. Symptoms: Loud and chronic snoring, Choking, snorting, or gasping during sleep, Long pauses in breathing, Daytime sleepiness, no matter how much time you spend in bed. Cheyne Stokes Breathing or gasping for breath is another problem also usually associated with sleep apnea. There are also varying types of breathing machines that can help with sleep apnea, including a CPAP, which provides steady pressure to overcome the obstruction, BPAP, a machine for those who have trouble adjusting to a CPAP and it provides bi-level pressure and can even provide more pressure when it detects you have not taken a breath, and VPAP, which is used for both Central and Obstructive, and measures the oxygen, CO-2 levels and constantly adjusts your pressure. There are also devices for opening the airways including various dental devices used for mild sleep apnea, and sugery when sleep apnea machines do not work. Finally, it is vitally important for anyone diagnosed with sleep apnea to use the machine. Failure to use it regularly every time you sleep can result in many serious problems up to and including death. If you think you have it, get it checked out and follow your doctors advice for treatment.
  • Elizabeth  •  3 months ago
    Snoring is associated with sleep apnea. Sleep apnea is associated with silent strokes. Did they only find a high correlation, or did they determine a causitive effect? If there is a degree of causation, anyone who snores needs to be checked out.
  • Michael  •  3 months ago
    the cpap made a great difference in how I sleep
  • vickietoria  •  3 months ago
    My father had what was thought a heart attack over a decade ago but angiogram showed clear passages. It was only then that it was determined that he had severe sleep apnia - as if his snoring, fatigue and depression didn't give a hint. He's been on a cpap machine since then and is doing great. A colleague's father had a full heart check up with a stress test but died two days later - later attributed to apnia related stroke. It IS a silent killer and people should take it very seriously. The slight adjustment to the sleep machine is worth averting the worst outcome.
  • Tom  •  Boston, Massachusetts  •  3 months ago
    Anyone who snores heavily should be checked for sleep appenea. My wife told me to go get checkout out for years, but I never did. Then one day I ended up getting tested and found out I was an Atrical Fibulation - a condition that causes an irregular heartbeat and can lead to stroke. The root cause was my appenea which was extremelly high (70ish). I got on a CPAP and not my score is less than 5 per night (which is considered normal) and my heart is back in normal rythym. Bottom line take snoring seriously.