Association between obstructive sleep apnea and risk of post-stroke depression: A hospital-based study in ischemic stroke patients

Background and Aims: Obstructive sleep apnea (OAS) is a common contributor as well as a frequent co-morbid condition in ischemic stroke. This study aimed to detect the correlation between OSA severity and post-stroke depression (PSD) in ischemic stroke patients. Methods: From Mar 2017 to Dec 2018, 265 patients with symptom onset less than 14 days were consecutively recruited. All patients underwent polysomnography examination for diagnosis of OSA during hospitalization. PSD was identified using the Chinese version of the Structured Clinical Interview for DSM-IV at admission and 3-month. Logistic regression analyses were performed to assess the association between OSA severity and PSD. Results: Among the 265 patients, the distribution of patients in terms of the OSA severity was as follows: 48 (18.1%) had no OSA, 85 (32.1%) had mild OSA, 54 (20.4%) had moderate OSA, and 78 (29.4%) had severe OSA. Patients diagnosed as PSD at admission and 3-month were 63 (23.8%) and 86 (32.5%), respectively. Univariate analysis showed that reduced OSA severity was correlated with PSD at 3-month (P = 0.003), but not at admission (P = 0.373). In multivariable analysis, after adjustment for covariates, severe OSA (compared with the patients without OSA; odds ratio, 4.04; 95% confidence interval, 1.38-9.62; P = 0.036) was significantly associated with increasing risk of 3-month PSD. Furthermore, multiple-adjusted spline regression model further confirmed a dose-response relationship between apnea-hypopnea index and 3-month PSD (P for linearity < 0.001). Conclusions: Our data showed that OSA severity was positively associated with 3-month PSD in ischemic stroke patients.