Increased risk for subarachnoid hemorrhage in patients with sleep apnea.

Objectives: Recent retrospective studies found sleep disorders, including obstructive sleep apnea and its symptoms to occur more often in patients following aneurysmal subarachnoid hemorrhage, but studies investigating the incidence of subarachnoid hemorrhage in patients with diagnosed obstructive sleep apnea [OSA] compared to other sleep disorders are missing.

Methods: To test our hypothesis that aneurysmal subarachnoid hemorrhage occurs more often in patients with OSA compared to other sleep disorders, we analyzed clinical data of 5514 patients with OSA, 4150 with other sleep disorders, and 964 patients with aneurysmal subarachnoid hemorrhage diagnosed between 01/01/2007 and 12/31/2016. As a secondary outcome, location and size of the ruptured aneurysm were calculated based on computer tomography. Incidence of SAH, as well as size and location were compared between patients with OSA and patients with other sleep disorders, diagnosed by polysomnography.

Results: Aneurysmal subarachnoid hemorrhage occurred in 8.3 per 100,000 patients with sleep disorders per year. Its incidence was significantly higher in patients with obstructive sleep apnea (14.5 per 100,000 patients per year), compared to other sleep disorders (2.4 per 100,000 patients per year; RR = 6.8; p = 0.04). The size of the ruptured aneurysm was larger in patients with OSA (19.0 ± 5.7 mm vs. 8.5 ± 0.5 mm; p = 0.004).

Interpretation: Aneurysmal subarachnoid hemorrhage occurs more often in patients with diagnosed OSA compared to patients with other sleep disorders, possibly due to increased aneurysm enlargement. Obstructive sleep apnea might be a yet unrecognized risk factor for aneurysmal subarachnoid hemorrhage, and sleep apnea screening should be considered in patients with intracranial aneurysm.