Impact of Comorbid Sleep-Disordered Breathing and Atrial Fibrillation on the Long-Term Outcome After Ischemic Stroke.

Yang, Xiaoli; Lippert, Julian; Dekkers, Martijn; Baillieul, Sebastien; Duss, Simone B; Reichlin, Tobias; Brill, Anne-Kathrin; Bernasconi, Corrado; Schmidt, Markus H; Bassetti, Claudio L A (2024). Impact of Comorbid Sleep-Disordered Breathing and Atrial Fibrillation on the Long-Term Outcome After Ischemic Stroke. Stroke, 55(3), pp. 586-594. Wolters Kluwer Health 10.1161/STROKEAHA.123.042856

yang-et-al-2024-impact-of-comorbid-sleep-disordered-breathing-and-atrial-fibrillation-on-the-long-term-outcome-after.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (554kB) | Preview


Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke. Little is known about the impact of comorbid SDB and AF on long-term outcomes after stroke.


In this prospective cohort study, 353 patients with acute ischemic stroke or transient ischemic attacks were analyzed. Patients were screened for SDB by respiratory polygraphy during acute hospitalization. Screening for AF was performed using a 7-day ECG up to 3× in the first 6 months. Follow-up visits were scheduled at 1, 3, 12, 24, and 36 months poststroke. Cox regression models adjusted for various factors (age, sex, body mass index, hypertension, diabetes, dyslipidemia, and heart failure) were used to assess the impact of comorbid SDB and AF on subsequent death or cerebro-cardiovascular events.


Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67 (interquartile range, 57-74) years with 63% males. Moderate-to-severe SDB (apnea-hypopnea index score, ≥15/h) was present in 118 (33.4%) patients. Among the 56 (15.9%) patients with AF, 28 had comorbid moderate-to-severe SDB and AF. Over 36 months, there were 12 deaths and 67 recurrent cerebro-cardiovascular events. Patients with comorbid moderate-to-severe SDB and AF had a higher risk of subsequent death or cerebro-cardiovascular events compared with those with only moderate-to-severe SDB without AF (hazard ratio, 2.49 [95% CI, 1.18-5.24]) and to those without moderate-to-severe SDB or AF (hazard ratio, 2.25 [95% CI, 1.12-4.50]). However, no significant difference was found between the comorbid moderate-to-severe SDB and AF group and the group with only AF without moderate-to-severe SDB (hazard ratio, 1.64 [95% CI, 0.62-4.36]).


Comorbid moderate-to-severe SDB and AF significantly increase the risk of long-term mortality or recurrent cerebro-cardiovascular events after acute ischemic stroke. Considering both conditions as cumulative and modifiable cerebro-cardiovascular risk factors is of interest for the management of acute stroke.


URL:; Unique identifier: NCT02559739.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Yang, Xiaoli, Lippert, Julian Peter, Dekkers, Martijn, Duss, Simone, Reichlin, Tobias Roman, Brill, Anne-Kathrin, Bernasconi, Corrado Angelo, Schmidt, Markus Helmut, Bassetti, Claudio L.A.


600 Technology > 610 Medicine & health




Wolters Kluwer Health




Pubmed Import

Date Deposited:

26 Jan 2024 15:29

Last Modified:

27 Feb 2024 00:15

Publisher DOI:


PubMed ID:


Additional Information:

X. Yang and J. Lippert contributed equally.

Uncontrolled Keywords:

atrial fibrillation heart failure hypertension ischemic stroke stroke




Actions (login required)

Edit item Edit item
Provide Feedback