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Volume 14 No. 05
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Accepted Papers

Scientific Investigations

Lack of Worsening of Sleep-Disordered Breathing After Recurrent Stroke in the BASIC Project

Devin L. Brown, MD1; Chengwei Li, MPH1,2; Brisa N. Sánchez, PhD3; Galit Levi Dunietz, PhD4; Ronald D. Chervin, MD, MS4; Erin Case, BA1,2; Nelda M. Garcia, BS1,2; Lynda D. Lisabeth, PhD1,2
1Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; 2Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; 3Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan; 4Sleep Disorders Center and Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan

Study Objectives:

To investigate the difference in sleep-disordered breathing (SDB) prevalence and severity after an index and recurrent stroke.


In a sample of 40 subjects, home sleep apnea tests were performed a median of 10 days after an index ischemic stroke and 14 days after a recurrent ischemic stroke. A respiratory event index (REI) of ≥ 10 events/h (apneas plus hypopneas per hour of recording) was used to define clinically significant SDB. The relative difference in REI or relative SDB prevalence was used to compare the post-recurrent stroke measurement with that made after the index stroke, and was expressed as a rate ratio (RR) or prevalence ratio (PR). Adjusted regression models (negative binomial for REI and log binomial for SDB) included change in body mass index and time between the events.


The median time from index to recurrent stroke was 330.5 days (interquartile range [IQR]: 103.5, 766.5). The median REI was 17.5 (IQR: 9.0, 32.0) after the index stroke and 18.0 (IQR: 11.0, 25.5) after the recurrent stroke. The within-subject median difference was zero (IQR: −9, 7.5). The relative difference in REI was not significant in unadjusted or adjusted (RR: 0.97 [95% confidence interval: 0.76, 1.24]) models. The prevalence of SDB was not different after the recurrent stroke compared with the index stroke, in unadjusted or adjusted (PR: 1.10 [95% confidence interval: 0.91, 1.32]) models.


In this within-subject, longitudinal study, neither severity nor prevalence of SDB worsened after recurrent stroke.


Brown DL, Li C, Sánchez BN, Dunietz GL, Chervin RD, Case E, Garcia NM, Lisabeth LD. Lack of worsening of sleep-disordered breathing after recurrent stroke in the BASIC project. J Clin Sleep Med. 2018;14(5):835–839.

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