Gender disparity in a cohort of stroke patients with incidence of obstructive sleep apnea.

Background: Differences in baseline clinical risk factors have been proposed to contribute to gender differences in stroke outcome, how these clinical risk factors contribute to gender difference in acute ischemic stroke (AIS) patients with obstructive sleep apnea is yet to be fully investigated. This study explored the clinical characteristics associated with gender differences in AIS population with a baseline obstructive sleep apnea(OSA).

Methods: A retrospective study was conducted using data from 5469 patients with an ischemic stroke event from a regional stroke center collected from January 2010 to June 2016. Multivariate logistic regression was used to determine factors associated with gender differences in the obstructive sleep apnea-ischemic stroke population.

Results: A total of 170 AIS patients presented with a baseline OSA, and 101 were men and 69 were women. In the AIS with OSA (AIS-OSA) population, patients presenting with peripheral vascular disease (PVD) (OR = 4.892, 95% CI,1.248 - 19.2, P = 0.023), depression (OR = 3.804, 95% CI, 1.369 - 10.6, P = 0.01), higher BMI (OR = 1.103, 95% CI, 1.036 - 1.18, P = 0.002), and higher HDL levels (OR = 1.125, 95% CI, 1.067 - 1.19, P = < 0.001) were associated with increasing odds of being women, and no clinical risk factor was associated with men AIS-OSA patients.

Conclusion: A gender specific difference was observed in pre-stroke demographic and risk factors for AIS patients with OSA. Women AIS patients with OSA were more likely to present with PVD and depression and have higher HDL and BMI levels when compared to men within the same population. In addition, more men AIS presented with OSA when compared with women AIS patients. Further studies to explore management strategies to eliminate gender differences will improve outcomes for men and women AIS with OSA.