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Volume 14 No. 12
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Accepted Papers

Scientific Investigations

The Evolution of Sleep Apnea Six Months After Acute Ischemic Stroke and Thrombolysis

Jaana K. Huhtakangas, MD1; Tarja Saaresranta, MD, PhD2; Risto Bloigu, MSc3; Juha Huhtakangas, MD, PhD4
1Respiratory Medicine Unit, Institute of Clinical Medicine, Oulu University Hospital, MRC Oulu, Finland; 2Turku University Hospital, Division of Medicine, Department of Pulmonary Diseases and Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland; 3Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland; 4Department of Neurology, Oulu University Hospital and University of Oulu, Oulu, Finland

Study Objectives:

Our goal was to investigate the evolution of prevalence, severity, and type of sleep apnea among patients who had an ischemic stroke, with or without treatment with thrombolysis after 6 months.


We prospectively studied 204 patients who had an ischemic stroke (110 in the thrombolysis and 94 in the non-thrombolysis group). After follow-up, 177 patients were eligible for a final analysis (98 in the thrombolysis group and 79 in the non-thrombolysis group). An unattended sleep study with a three-channel portable device was performed both on admission and after the 6-month follow-up.


The patients receiving thrombolysis were younger than those in the non-thrombolysis group (mean 65.5 versus 69.6 years P = .039). Sleep apnea, defined as a respiratory event index (REI) ≥ 5 events/h, was diagnosed in 92.7% patients, 93.9% versus 91.1% (P = .488) in the thrombolysis and non-thrombolysis groups, respectively. The prevalence remained unchanged during follow-up. Mild sleep apnea progressed to moderate or severe sleep apnea in 69.2% of the patients. Globally, mean central apneas per hour increased by 2.2% (P = .002), whereas obstructive apneas declined by 1.7% (P = .014). The mean change of oxygen desaturation index was −6.1% (P < .001) in the thrombolysis group, −1.8% (P = .327) in the non-thrombolysis group, and 4.2% (P = .001) in the whole group. In the non-thrombolysis group, the risk for new sleep apnea incidence increased by 6.1-fold (P = .024) at follow-up when compared to the thrombolysis group.


Sleep apnea prevalence remained high in patients who had an ischemic stroke at 6 months post-stroke. The risk for developing sleep apnea after stroke was significantly lower among patients undergoing thrombolysis.

Clinical Trial Registration:

Registry:; Title: Ischaemic Stroke and Sleep Apnea in Northern Part of Finland; Identifier: NCT01861275; URL:


Huhtakangas JK, Saaresranta T, Bloigu R, Huhtakangas J. The evolution of sleep apnea six months after acute ischemic stroke and thrombolysis. J Clin Sleep Med. 2018;14(12):2005–2011.

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