The finding that severe OSA is not independently associated with
stroke recurrence contradicts previous studies in which acute stroke
patients were examined using a portable system [3,4]. Rola et al.
[4] studied 72 subjects after mild ischemic stroke or transient ischemic attack, and concluded that sleep-disordered breathing (SDB)
significantly increased the incidence of recurrent stroke in a 2-year
follow-up. In their study, SBD was not further classified into an obstructive or central type. Previous studies have also demonstrated
that the prevalence of CSA is higher in the acute phase of stroke,
with a tendency to decrease in the chronic phase [40]. Therefore,
attributing the increased incidence of recurrent stroke found in their
study to the OSA alone would be inappropriate. Dziewas et al. [3]
prospectively studied 102 acute stroke patients, and indicated that
SDB is an independent risk factor for stroke recurrence. However,
their study had two major limitations: the forward stepwise logistic regression analysis and that SDB was evaluated simultaneously
with the nasal oxygen supply. Biologists are advised to refrain from
applying stepwise model selection methods [41]. As age is an independent predictor of severe OSA in stroke patients [42], logistic
regression analysis using forward stepwise or entering methods
might yield different results. In this study, AHI was independently
associated with stroke recurrence by the forward stepwise method.
However, AHI failed to maintain the independent association for
stroke recurrence after forcefully entering “age” into the equation.
The second limitation was that SDB was evaluated simultaneously
with the nasal oxygen supply. Exactly how oxygen supply affects
the severity of OSA in acute stroke
The finding that severe OSA is not independently associated withstroke recurrence contradicts previous studies in which acute strokepatients were examined using a portable system [3,4]. Rola et al.[4] studied 72 subjects after mild ischemic stroke or transient ischemic attack, and concluded that sleep-disordered breathing (SDB)significantly increased the incidence of recurrent stroke in a 2-yearfollow-up. In their study, SBD was not further classified into an obstructive or central type. Previous studies have also demonstratedthat the prevalence of CSA is higher in the acute phase of stroke,with a tendency to decrease in the chronic phase [40]. Therefore,attributing the increased incidence of recurrent stroke found in theirstudy to the OSA alone would be inappropriate. Dziewas et al. [3]prospectively studied 102 acute stroke patients, and indicated thatSDB is an independent risk factor for stroke recurrence. However,their study had two major limitations: the forward stepwise logistic regression analysis and that SDB was evaluated simultaneouslywith the nasal oxygen supply. Biologists are advised to refrain fromapplying stepwise model selection methods [41]. As age is an independent predictor of severe OSA in stroke patients [42], logisticregression analysis using forward stepwise or entering methodsmight yield different results. In this study, AHI was independentlyassociated with stroke recurrence by the forward stepwise method.However, AHI failed to maintain the independent association forstroke recurrence after forcefully entering “age” into the equation.The second limitation was that SDB was evaluated simultaneouslywith the nasal oxygen supply. Exactly how oxygen supply affectsthe severity of OSA in acute stroke
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