Phenotypic traits of sleep-apnea post-stroke: insights from the analysis of the pan-European ESADA cohort

<bold>Background:</bold> International guidelines recommend obstructive sleep apnea (OSA) screening post-stroke, but epidemiological evidence of their application is lacking. We aimed to describe the prevalence and phenotypic traits of stroke patients in a prospective real-life cohort of patients with suspected OSA. <bold>Methods:</bold> Adult patients (age 18–80 years) with suspected OSA were prospectively included in the European Sleep Apnea Database (ESADA, 39 sleep medicine centers). Exclusion criteria are previous diagnosis of OSA, limited life expectancy, and alcohol or drug abuse. Demographic and anthropometric data, Epworth Sleepiness Scale (ESS) score, and medical history, including stroke, were recorded. OSA diagnosis was based on polysomnography or polygraphy. <bold>Results:</bold> Among the 33,359 patients prospectively included between 2007 and 2022, 793 (2.4%) patients presented a history of stroke. Stroke patients were significantly older (median [IQR] age=63.0[55.0;71.0] years vs. 54.0[44.0;62.0], p<0.001), predominantly males (73.5% vs. 70.1%, p=0.04), and presented a significantly higher apnea-hypopnea index (26.7[13.0;47.0] events/h vs. 24.0[9.6;46.3], p=0.003), and higher rate of comorbid insomnia (5.2% vs. 3.4%, p=0.005). Stroke patients presented a higher prevalence of hypertension (68.6% vs. 43.7%), ischemic heart disease (21.7% vs. 7.7%), or diabetes (27.9% vs. 15.2%) (all p<0.001). No difference was observed in BMI, ESS, and prevalence of other sleep comorbidities. <bold>Conclusion:</bold> Stroke patients referred to OSA screening present specific phenotypic traits, with greater OSA severity and prevalence of comorbid insomnia. Structured care pathways are required to improve OSA screening post-stroke.