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Sleep-disordered breathing assessed by holter-monitoring is associated to worsened one-year clinical outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis

Session Stroke - The heart brain axis

Speaker Dong Oh Kang

Event : ESC Congress 2019

  • Topic : diseases of the aorta, peripheral vascular disease, stroke
  • Sub-topic : Stroke – Epidemiology, Prognosis, Outcome
  • Session type : Moderated Posters

Authors : DO Kang (Seoul,KR), CK Kim (Seoul,KR), Y Park (Seoul,KR), WY Jang (Seoul,KR), W Kim (Seoul,KR), JY Choi (Seoul,KR), CU Choi (Seoul,KR), JO Na (Seoul,KR)

DO Kang1 , CK Kim2 , Y Park1 , WY Jang1 , W Kim1 , JY Choi1 , CU Choi1 , JO Na1 , 1Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine - Seoul - Korea (Republic of) , 2Korea University Guro Hospital, Department of Neurology - Seoul - Korea (Republic of) ,


Background: Sleep-disorder breathing (SDB) using polysomnography is closely associated to poor functional and clinical outcomes in ischemic stroke patients. The cardiopulmonary coupling analysis using Holter-monitoring (CPC-Holter analysis) is an emerging feasible modality to investigate SDB.

Purpose: We investigated the association between SDB defined by CPC-Holter analysis and one-year clinical outcome in patients with acute ischemic stroke.

Methods: Total 666 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC-Holter analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. Primary outcome was recurrent ischemic stroke, and secondary outcome was major adverse cerebrovascular event (MACE), a composite of recurrent ischemic stroke, transient ischemic attack, and all-cause mortality within one year since discharge.

Result: The NB coupling was present in 205 (30.8%) of 666 patients with mean age of 64.1 ± 12.8 years. The NB group showed significantly higher incidence of both recurrent ischemic stroke (8.3% vs. 1.4%, p<0.001) and MACE (14.9% vs. 3.0%, p<0.001) within one-year. In multivariate analysis, presence of NB coupling remained as an independent predictor of both recurrent ischemic stroke and MACE (HR: 4.81; 95% CI: 1.73-13.4; p=0.003; and HR 4.17; 95% CI: 1.74-10.0; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 164 patient pairs (C-statistics=0.757).

Conclusion: SDB assessed by CPC-Holter analysis at early phase of ischemic stroke is a powerful prognostic marker for predicting one-year adverse clinical outcomes. The CPC analysis using Holter-monitoring is a useful modality and could be easily applied to predict clinical outcomes in acute ischemic stroke patients.

Overall population (n=666) PSM population (n=328)
no NB (=461) NB (n=205) Log-rank p-value OR (95% CI) no NB (n=164) NB (n=164) Log-rank p-value OR (95% CI)
Recurrent ischemic stroke 6 (1.4) 14 (8.3) <0.001 5.73 (2.20-14.9) 3 (2.0) 11 (8.1) 0.026 3.85 (1.07-13.8)
Transient ischemic attack 3 (0.7) 3 (1.7) 0.275 2 (1.3) 3 (2.1) 0.633
Hemorrhagic stroke 0 (0.0) 2 (1.2) 0.027 0 (0.0) 2 (1.5) 0.148
Total death 3 (0.7) 9 (4.8) 0.001 2 (1.3) 3 (1.9) 0.641
MACEs 12 (3.0) 25 (14.9) <0.001 4.63 (2.06-10.4) 7 (5.2) 17 (13.1) 0.030 2.95 (1.06-8.21)
Data are expressed as n (%). CI = confidence interval; MACE = major adverse cardiovascular event; NB = narrow-band; OR = odds ratio

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