Obstructive Sleep Apnea as a Risk Factor for Intracerebral Hemorrhage

Stroke. 2021 May;52(5):1835-1838. doi: 10.1161/STROKEAHA.120.033342. Epub 2021 Apr 8.


Background and purpose: To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls.

Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid OSA. We performed logistic regression analyses to evaluate the association between OSA and ICH.

Results: Two thousand and sixty-four (71%) cases and 1516 (52%) controls were classified as having OSA by the Berlin Questionnaire. Cases with OSA were significantly more likely to be male and have hypertension, heart disease, hyperlipidemia, and higher body mass index compared with those without OSA. OSA was more common among cases compared with controls (71% versus 52%, odds ratio, 2.28 [95% CI, 2.05-2.55]). In a multivariable logistic regression model, OSA was associated with increased risk for ICH (odds ratio, 1.47 [95% CI, 1.29-1.67]).

Conclusions: OSA is a risk factor for ICH.

Keywords: apnea; cerebral hemorrhage; diabetes; heart disease; hypertension; obesity; stroke.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Body Mass Index
  • Case-Control Studies
  • Cerebral Hemorrhage / etiology*
  • Female
  • Heart Diseases / complications
  • Humans
  • Hyperlipidemias / complications
  • Hypertension / complications
  • Male
  • Middle Aged
  • Risk Factors
  • Sex Factors
  • Sleep Apnea, Obstructive / complications*
  • Surveys and Questionnaires