Joint Associations of Sleep-Disordered Breathing and Cerebral Small Vessel Disease Burden With Executive Performance, Balance, and In-Hospital Falls in Patients With Subacute Supratentorial Ischemic Stroke Undergoing Inpatient Rehabilitation.

Abstract

To examine the joint associations of magnetic resonance imaging-based total cerebral small vessel disease burden and sleep-disordered breathing with Stroop-based executive performance, balance, and in-hospital falls after subacute supratentorial ischemic stroke. Retrospective cohort study of 1,050 adults with first-ever supratentorial ischemic stroke admitted for inpatient rehabilitation. The apnea-hypopnea index was measured using portable sleep monitoring, and total cerebral small vessel disease burden was scored on brain magnetic resonance imaging. Low Stroop-based executive performance occurred in 437 patients (41.6%), and 110 patients (10.5%) experienced in-hospital falls. Apnea-hypopnea index per 10 events/h (β, -0.80; 95% CI, -1.26 to -0.34; P<0.001) and total cerebral small vessel disease burden per 1-point increase (β, -1.62; 95% CI, -2.25 to -0.99; P<0.001) were associated with lower Stroop-based executive composite scores; the interaction term was negative and modest (β, -0.23; 95% CI, -0.46 to -0.01; P=0.042). The dual-risk phenotype was associated with low Stroop-based executive performance (OR, 5.99; 95% CI, 4.03 to 8.88) and in-hospital falls (OR, 3.72; 95% CI, 1.91 to 7.24). Sleep-disordered breathing and cerebral small vessel disease burden were jointly associated with poorer Stroop-based executive and balance outcomes and an increased risk of in-hospital falls.