The following is a summary of “Sleep Apnea and Incident Stroke in a National Cohort of Black and White Adults,” published in the March 2024 issue of Neurology by Robbins, et al.

While obstructive sleep apnea (OSA) is linked to stroke risk, variations in OSA symptoms, treatment, and their association with stroke across races remain unclear and potentially contribute to unequal stroke rates.

Researchers conducted a retrospective study investigating the connection between OSA symptoms and stroke occurrence, stratified by race/ethnicity.

They analyzed data gathered from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort of Black and White individuals in the US. Only participants without a prior stroke diagnosis were included. Self-reported factors included snoring, daytime sleepiness, provider-diagnosed sleep apnea (PDSA), and treatment for PDSA using positive airway pressure (PAP). The risk of OSA was classified as high or low based on the Berlin Sleep Questionnaire. Incident stroke was defined as the first occurrence of stroke over an average follow-up period of 12 years (SD 3.9). Using Cox proportional hazards models, snoring, OSA risk, PDSA, PAP therapy use, and incident stroke by race/ethnicity were analyzed, adjusting for demographic, socioeconomic, and stroke risk factors.

The results showed 22,192 participants, with an average age of 64.2 years (SD 9.1), 38.1% identified as Black. Significantly, there was no link between snoring and new stroke cases (HR 0.98, 95% CI 0.85–1.13). In white participants, increased risk of OSA and PDSA was associated with new stroke occurrences (HR 1.22, 95% CI 1.01–1.47; HR 1.33, 95% CI 1.04–1.70, respectively). The use of positive airway PAP therapy by individuals with PDSA, as opposed to those without, was associated with an increased risk of stroke in white populations (HR 1.38, 95% CI 1.05–1.80). On the other hand, Black individuals with PDSA had a lower risk of stroke when using PAP therapy compared to those without it, while white individuals did not show the same reduction in stroke risk with PAP therapy.

Investigators concluded that racial differences in stroke risk were linked to OSA, with white individuals experiencing higher risk and Black PAP users showing lower risk, necessitating further research.

Source: neurology.org/doi/10.1212/WNL.0000000000209171