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Published in: Journal of Neurology 5/2022

Open Access 01-05-2022 | Sleep Apnea | Original Communication

Sleep-disordered breathing-related symptoms and risk of stroke: cohort study and Mendelian randomization analysis

Authors: Olga E. Titova, Shuai Yuan, John A. Baron, Eva Lindberg, Karl Michaëlsson, Susanna C. Larsson

Published in: Journal of Neurology | Issue 5/2022

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Abstract

Background

Sleep-disordered breathing (SDB) may contribute to development of stroke. However, findings are inconclusive. We investigated whether SDB-related symptoms are associated with incidence of stroke and its types in a general community sample of adult men and women as well as to perform Mendelian randomization (MR) analysis.

Methods

We used data from a cohort of 41,742 Swedish adults (56–94 years of age) who completed questionnaires regarding snoring, cessation of breathing, lifestyle and health characteristics. Participants were followed up for incident stroke and death over 8 years through linkage to the Swedish Registers. Hazard ratios, adjusted for potential confounders, were estimated by Cox proportional hazards regression. MR analyses were performed using single-nucleotide polymorphisms associated with sleep apnea at the genome-wide significance level and summary-level data for stroke and its subtypes from consortia and a meta-analysis of Genome-Wide Association Studies.

Results

In the cohort study, symptoms of disturbing snoring and/or cessation of breathing were associated with increased risk of total stroke (hazard ratio 1.12, 95% confidence interval 1.02–1.24) and intracerebral hemorrhage (hazard ratio 1.59, 95% confidence interval 1.23–2.05) but not with ischemic stroke or subarachnoid hemorrhage. MR analyses showed no association of genetic liability to sleep apnea with the risk of overall stroke or any specific types of stroke or ischemic stroke subtypes.

Conclusions

SDB-related symptoms were associated with increased risk of total stroke, specifically intracerebral hemorrhage, in the observational analyses but not in the MR analyses. There was limited evidence of an association of SDB with ischemic stroke and subarachnoid hemorrhage.
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Literature
1.
go back to reference Al Lawati NM, Patel SR, Ayas NT (2009) Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis 51:285–293CrossRefPubMed Al Lawati NM, Patel SR, Ayas NT (2009) Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis 51:285–293CrossRefPubMed
3.
go back to reference Arzt M, Young T, Finn L, Skatrud JB, Bradley TD (2005) Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451CrossRefPubMedPubMedCentral Arzt M, Young T, Finn L, Skatrud JB, Bradley TD (2005) Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451CrossRefPubMedPubMedCentral
4.
go back to reference Bakker MK, van der Spek RAA, van Rheenen W, Morel S, Bourcier R, Hostettler IC, Alg VS, van Eijk KR, Koido M, Akiyama M, Terao C, Matsuda K, Walters RG, Lin K, Li L, Millwood IY, Chen Z, Rouleau GA, Zhou S, Rannikmae K, Sudlow CLM, Houlden H, van den Berg LH, Dina C, Naggara O, Gentric JC, Shotar E, Eugene F, Desal H, Winsvold BS, Borte S, Johnsen MB, Brumpton BM, Sandvei MS, Willer CJ, Hveem K, Zwart JA, Verschuren WMM, Friedrich CM, Hirsch S, Schilling S, Dauvillier J, Martin O, Stroke HA-I, China Kadoorie Biobank Collaborative G, BioBank Japan Project C, Group IS, Group C, Genetics, Observational Subarachnoid Haemorrhage Study i, International Stroke Genetics C, Jones GT, Bown MJ, Ko NU, Kim H, Coleman JRI, Breen G, Zaroff JG, Klijn CJM, Malik R, Dichgans M, Sargurupremraj M, Tatlisumak T, Amouyel P, Debette S, Rinkel GJE, Worrall BB, Pera J, Slowik A, Gaal-Paavola EI, Niemela M, Jaaskelainen JE, von Und Zu, Fraunberg M, Lindgren A, Broderick JP, Werring DJ, Woo D, Redon R, Bijlenga P, Kamatani Y, Veldink JH, Ruigrok YM (2020) Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors. Nat Genet 52:1303–1313CrossRefPubMedPubMedCentral Bakker MK, van der Spek RAA, van Rheenen W, Morel S, Bourcier R, Hostettler IC, Alg VS, van Eijk KR, Koido M, Akiyama M, Terao C, Matsuda K, Walters RG, Lin K, Li L, Millwood IY, Chen Z, Rouleau GA, Zhou S, Rannikmae K, Sudlow CLM, Houlden H, van den Berg LH, Dina C, Naggara O, Gentric JC, Shotar E, Eugene F, Desal H, Winsvold BS, Borte S, Johnsen MB, Brumpton BM, Sandvei MS, Willer CJ, Hveem K, Zwart JA, Verschuren WMM, Friedrich CM, Hirsch S, Schilling S, Dauvillier J, Martin O, Stroke HA-I, China Kadoorie Biobank Collaborative G, BioBank Japan Project C, Group IS, Group C, Genetics, Observational Subarachnoid Haemorrhage Study i, International Stroke Genetics C, Jones GT, Bown MJ, Ko NU, Kim H, Coleman JRI, Breen G, Zaroff JG, Klijn CJM, Malik R, Dichgans M, Sargurupremraj M, Tatlisumak T, Amouyel P, Debette S, Rinkel GJE, Worrall BB, Pera J, Slowik A, Gaal-Paavola EI, Niemela M, Jaaskelainen JE, von Und Zu, Fraunberg M, Lindgren A, Broderick JP, Werring DJ, Woo D, Redon R, Bijlenga P, Kamatani Y, Veldink JH, Ruigrok YM (2020) Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors. Nat Genet 52:1303–1313CrossRefPubMedPubMedCentral
5.
go back to reference Bliwise DL, Nekich JC, Dement WC (1991) Relative validity of self-reported snoring as a symptom of sleep apnea in a sleep clinic population. Chest 99:600–608CrossRefPubMed Bliwise DL, Nekich JC, Dement WC (1991) Relative validity of self-reported snoring as a symptom of sleep apnea in a sleep clinic population. Chest 99:600–608CrossRefPubMed
7.
go back to reference Bowden J, Davey Smith G, Burgess S (2015) Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol 44:512–525CrossRefPubMedPubMedCentral Bowden J, Davey Smith G, Burgess S (2015) Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol 44:512–525CrossRefPubMedPubMedCentral
8.
go back to reference Campos AI, Ingold N, Huang Y, Kho PF, Han X, Ong J-S, Garcia-Marin LM, Law MH, Martin NG, Dong X, Cuellar-Partida G, MacGregor S, Aslibekyan S, Renteria ME (2020) Genome-wide analyses in 1,987,836 participants identify 39 genetic loci associated with sleep apnoea. medRxiv:2020. https://doi.org/10.1101/2020.09.29.20199893 Campos AI, Ingold N, Huang Y, Kho PF, Han X, Ong J-S, Garcia-Marin LM, Law MH, Martin NG, Dong X, Cuellar-Partida G, MacGregor S, Aslibekyan S, Renteria ME (2020) Genome-wide analyses in 1,987,836 participants identify 39 genetic loci associated with sleep apnoea. medRxiv:2020. https://​doi.​org/​10.​1101/​2020.​09.​29.​20199893
9.
go back to reference Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G (2019) Blood pressure non-dipping and obstructive sleep apnea syndrome: a meta-analysis. J Clin Med 8:1367CrossRefPubMedCentral Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G (2019) Blood pressure non-dipping and obstructive sleep apnea syndrome: a meta-analysis. J Clin Med 8:1367CrossRefPubMedCentral
10.
11.
go back to reference Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP Jr, Guilleminault C, Dement WC (1994) The sleep disorders questionnaire. I: Creation and multivariate structure of SDQ. Sleep 17:160–167CrossRefPubMed Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP Jr, Guilleminault C, Dement WC (1994) The sleep disorders questionnaire. I: Creation and multivariate structure of SDQ. Sleep 17:160–167CrossRefPubMed
13.
go back to reference Kimura Y, Miwa K, Takasugi J, Oyama N, Todo K, Sakaguchi M, Mochizuki H, Sasaki T (2020) Total small vessel disease score and functional outcomes following acute intracerebral hemorrhage. J Stroke Cerebrovasc Dis 29:105001CrossRefPubMed Kimura Y, Miwa K, Takasugi J, Oyama N, Todo K, Sakaguchi M, Mochizuki H, Sasaki T (2020) Total small vessel disease score and functional outcomes following acute intracerebral hemorrhage. J Stroke Cerebrovasc Dis 29:105001CrossRefPubMed
14.
go back to reference Liamsombut S, Kaw R, Wang L, Bena J, Andrews N, Collop N, Stierer T, Gillinov M, Tarler M, Kayyali H, Katzan I, Foldvary-Schaefer N (2021) Predictive value of sleep apnea screenings in cardiac surgery patients. Sleep Med 84:20–25CrossRefPubMed Liamsombut S, Kaw R, Wang L, Bena J, Andrews N, Collop N, Stierer T, Gillinov M, Tarler M, Kayyali H, Katzan I, Foldvary-Schaefer N (2021) Predictive value of sleep apnea screenings in cardiac surgery patients. Sleep Med 84:20–25CrossRefPubMed
15.
go back to reference Malik R, Chauhan G, Traylor M, Sargurupremraj M, Okada Y, Mishra A, Rutten-Jacobs L, Giese AK, van der Laan SW, Gretarsdottir S, Anderson CD, Chong M, Adams HHH, Ago T, Almgren P, Amouyel P, Ay H, Bartz TM, Benavente OR, Bevan S, Boncoraglio GB, Brown RD Jr, Butterworth AS, Carrera C, Carty CL, Chasman DI, Chen WM, Cole JW, Correa A, Cotlarciuc I, Cruchaga C, Danesh J, de Bakker PIW, DeStefano AL, den Hoed M, Duan Q, Engelter ST, Falcone GJ, Gottesman RF, Grewal RP, Gudnason V, Gustafsson S, Haessler J, Harris TB, Hassan A, Havulinna AS, Heckbert SR, Holliday EG, Howard G, Hsu FC, Hyacinth HI, Ikram MA, Ingelsson E, Irvin MR, Jian X, Jimenez-Conde J, Johnson JA, Jukema JW, Kanai M, Keene KL, Kissela BM, Kleindorfer DO, Kooperberg C, Kubo M, Lange LA, Langefeld CD, Langenberg C, Launer LJ, Lee JM, Lemmens R, Leys D, Lewis CM, Lin WY, Lindgren AG, Lorentzen E, Magnusson PK, Maguire J, Manichaikul A, McArdle PF, Meschia JF, Mitchell BD, Mosley TH, Nalls MA, Ninomiya T, O’Donnell MJ, Psaty BM, Pulit SL, Rannikmae K, Reiner AP, Rexrode KM, Rice K, Rich SS, Ridker PM, Rost NS, Rothwell PM, Rotter JI, Rundek T, Sacco RL, Sakaue S, Sale MM, Salomaa V, Sapkota BR, Schmidt R, Schmidt CO, Schminke U, Sharma P, Slowik A, Sudlow CLM, Tanislav C, Tatlisumak T, Taylor KD, Thijs VNS, Thorleifsson G, Thorsteinsdottir U, Tiedt S, Trompet S, Tzourio C, van Duijn CM, Walters M, Wareham NJ, Wassertheil-Smoller S, Wilson JG, Wiggins KL, Yang Q, Yusuf S, Consortium AF, Cohorts for H, Aging Research in Genomic Epidemiology C, International Genomics of Blood Pressure C, Consortium I, Starnet, Bis JC, Pastinen T, Ruusalepp A, Schadt EE, Koplev S, Bjorkegren JLM, Codoni V, Civelek M, Smith NL, Tregouet DA, Christophersen IE, Roselli C, Lubitz SA, Ellinor PT, Tai ES, Kooner JS, Kato N, He J, van der Harst P, Elliott P, Chambers JC, Takeuchi F, Johnson AD, BioBank Japan Cooperative Hospital G, Consortium C, Consortium E-C, Consortium EP-I, International Stroke Genetics C, Consortium M, Neurology Working Group of the CC, Network NSG, Study UKYLD, Consortium M, Sanghera DK, Melander O, Jern C, Strbian D, Fernandez-Cadenas I, Longstreth WT Jr, Rolfs A, Hata J, Woo D, Rosand J, Pare G, Hopewell JC, Saleheen D, Stefansson K, Worrall BB, Kittner SJ, Seshadri S, Fornage M, Markus HS, Howson JMM, Kamatani Y, Debette S, Dichgans M (2018) Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet 50:524–537CrossRefPubMedPubMedCentral Malik R, Chauhan G, Traylor M, Sargurupremraj M, Okada Y, Mishra A, Rutten-Jacobs L, Giese AK, van der Laan SW, Gretarsdottir S, Anderson CD, Chong M, Adams HHH, Ago T, Almgren P, Amouyel P, Ay H, Bartz TM, Benavente OR, Bevan S, Boncoraglio GB, Brown RD Jr, Butterworth AS, Carrera C, Carty CL, Chasman DI, Chen WM, Cole JW, Correa A, Cotlarciuc I, Cruchaga C, Danesh J, de Bakker PIW, DeStefano AL, den Hoed M, Duan Q, Engelter ST, Falcone GJ, Gottesman RF, Grewal RP, Gudnason V, Gustafsson S, Haessler J, Harris TB, Hassan A, Havulinna AS, Heckbert SR, Holliday EG, Howard G, Hsu FC, Hyacinth HI, Ikram MA, Ingelsson E, Irvin MR, Jian X, Jimenez-Conde J, Johnson JA, Jukema JW, Kanai M, Keene KL, Kissela BM, Kleindorfer DO, Kooperberg C, Kubo M, Lange LA, Langefeld CD, Langenberg C, Launer LJ, Lee JM, Lemmens R, Leys D, Lewis CM, Lin WY, Lindgren AG, Lorentzen E, Magnusson PK, Maguire J, Manichaikul A, McArdle PF, Meschia JF, Mitchell BD, Mosley TH, Nalls MA, Ninomiya T, O’Donnell MJ, Psaty BM, Pulit SL, Rannikmae K, Reiner AP, Rexrode KM, Rice K, Rich SS, Ridker PM, Rost NS, Rothwell PM, Rotter JI, Rundek T, Sacco RL, Sakaue S, Sale MM, Salomaa V, Sapkota BR, Schmidt R, Schmidt CO, Schminke U, Sharma P, Slowik A, Sudlow CLM, Tanislav C, Tatlisumak T, Taylor KD, Thijs VNS, Thorleifsson G, Thorsteinsdottir U, Tiedt S, Trompet S, Tzourio C, van Duijn CM, Walters M, Wareham NJ, Wassertheil-Smoller S, Wilson JG, Wiggins KL, Yang Q, Yusuf S, Consortium AF, Cohorts for H, Aging Research in Genomic Epidemiology C, International Genomics of Blood Pressure C, Consortium I, Starnet, Bis JC, Pastinen T, Ruusalepp A, Schadt EE, Koplev S, Bjorkegren JLM, Codoni V, Civelek M, Smith NL, Tregouet DA, Christophersen IE, Roselli C, Lubitz SA, Ellinor PT, Tai ES, Kooner JS, Kato N, He J, van der Harst P, Elliott P, Chambers JC, Takeuchi F, Johnson AD, BioBank Japan Cooperative Hospital G, Consortium C, Consortium E-C, Consortium EP-I, International Stroke Genetics C, Consortium M, Neurology Working Group of the CC, Network NSG, Study UKYLD, Consortium M, Sanghera DK, Melander O, Jern C, Strbian D, Fernandez-Cadenas I, Longstreth WT Jr, Rolfs A, Hata J, Woo D, Rosand J, Pare G, Hopewell JC, Saleheen D, Stefansson K, Worrall BB, Kittner SJ, Seshadri S, Fornage M, Markus HS, Howson JMM, Kamatani Y, Debette S, Dichgans M (2018) Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet 50:524–537CrossRefPubMedPubMedCentral
16.
go back to reference Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR (2014) Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med 10:355–362CrossRefPubMedPubMedCentral Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR (2014) Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med 10:355–362CrossRefPubMedPubMedCentral
17.
go back to reference Molnar MZ, Mucsi I, Novak M, Szabo Z, Freire AX, Huch KM, Arah OA, Ma JZ, Lu JL, Sim JJ, Streja E, Kalantar-Zadeh K, Kovesdy CP (2015) Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax 70:888–895CrossRefPubMed Molnar MZ, Mucsi I, Novak M, Szabo Z, Freire AX, Huch KM, Arah OA, Ma JZ, Lu JL, Sim JJ, Streja E, Kalantar-Zadeh K, Kovesdy CP (2015) Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax 70:888–895CrossRefPubMed
18.
go back to reference Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, De La Torre G (2006) Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 37:2317–2321CrossRefPubMed Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, De La Torre G (2006) Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 37:2317–2321CrossRefPubMed
20.
go back to reference Poggesi A, Pasi M, Pescini F, Pantoni L, Inzitari D (2016) Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: a review. J Cereb Blood Flow Metab 36:72–94CrossRefPubMedPubMedCentral Poggesi A, Pasi M, Pescini F, Pantoni L, Inzitari D (2016) Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: a review. J Cereb Blood Flow Metab 36:72–94CrossRefPubMedPubMedCentral
22.
go back to reference Semelka M, Wilson J, Floyd R (2016) Diagnosis and treatment of obstructive sleep apnea in adults. Am Fam Physician 94:355–360PubMed Semelka M, Wilson J, Floyd R (2016) Diagnosis and treatment of obstructive sleep apnea in adults. Am Fam Physician 94:355–360PubMed
23.
go back to reference Smith GD, Ebrahim S (2003) “Mendelian randomization”: can genetic epidemiology contribute to understanding environmental determinants of disease? Int J Epidemiol 32:1–22CrossRefPubMed Smith GD, Ebrahim S (2003) “Mendelian randomization”: can genetic epidemiology contribute to understanding environmental determinants of disease? Int J Epidemiol 32:1–22CrossRefPubMed
24.
go back to reference Spiller W, Davies NM, Palmer TM (2019) Software application profile: mrrobust—a tool for performing two-sample summary Mendelian randomization analyses. Int J Epidemiol 48:684–690CrossRef Spiller W, Davies NM, Palmer TM (2019) Software application profile: mrrobust—a tool for performing two-sample summary Mendelian randomization analyses. Int J Epidemiol 48:684–690CrossRef
25.
go back to reference Stewart J, Manmathan G, Wilkinson P (2017) Primary prevention of cardiovascular disease: a review of contemporary guidance and literature. JRSM Cardiovasc Dis 6:2048004016687211PubMedPubMedCentral Stewart J, Manmathan G, Wilkinson P (2017) Primary prevention of cardiovascular disease: a review of contemporary guidance and literature. JRSM Cardiovasc Dis 6:2048004016687211PubMedPubMedCentral
26.
go back to reference Textor J, Hardt J (2011) DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology 22:745CrossRefPubMed Textor J, Hardt J (2011) DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology 22:745CrossRefPubMed
27.
go back to reference Verbanck M, Chen CY, Neale B, Do R (2018) Detection of widespread horizontal pleiotropy in causal relationships inferred from Mendelian randomization between complex traits and diseases. Nat Genet 50:693–698CrossRefPubMedPubMedCentral Verbanck M, Chen CY, Neale B, Do R (2018) Detection of widespread horizontal pleiotropy in causal relationships inferred from Mendelian randomization between complex traits and diseases. Nat Genet 50:693–698CrossRefPubMedPubMedCentral
28.
go back to reference Wang Y, Xu H, Qian Y, Guan J, Yi H, Yin S (2017) Patients with obstructive sleep apnea display decreased flow-mediated dilatation: evidence from a meta-analysis. Med Sci Monit 23:1069–1082CrossRefPubMedPubMedCentral Wang Y, Xu H, Qian Y, Guan J, Yi H, Yin S (2017) Patients with obstructive sleep apnea display decreased flow-mediated dilatation: evidence from a meta-analysis. Med Sci Monit 23:1069–1082CrossRefPubMedPubMedCentral
29.
go back to reference Woo D, Falcone GJ, Devan WJ, Brown WM, Biffi A, Howard TD, Anderson CD, Brouwers HB, Valant V, Battey TW, Radmanesh F, Raffeld MR, Baedorf-Kassis S, Deka R, Woo JG, Martin LJ, Haverbusch M, Moomaw CJ, Sun G, Broderick JP, Flaherty ML, Martini SR, Kleindorfer DO, Kissela B, Comeau ME, Jagiella JM, Schmidt H, Freudenberger P, Pichler A, Enzinger C, Hansen BM, Norrving B, Jimenez-Conde J, Giralt-Steinhauer E, Elosua R, Cuadrado-Godia E, Soriano C, Roquer J, Kraft P, Ayres AM, Schwab K, McCauley JL, Pera J, Urbanik A, Rost NS, Goldstein JN, Viswanathan A, Stogerer EM, Tirschwell DL, Selim M, Brown DL, Silliman SL, Worrall BB, Meschia JF, Kidwell CS, Montaner J, Fernandez-Cadenas I, Delgado P, Malik R, Dichgans M, Greenberg SM, Rothwell PM, Lindgren A, Slowik A, Schmidt R, Langefeld CD, Rosand J, International Stroke Genetics C (2014) Meta-analysis of genome-wide association studies identifies 1q22 as a susceptibility locus for intracerebral hemorrhage. Am J Hum Genet 94:511–521CrossRefPubMedPubMedCentral Woo D, Falcone GJ, Devan WJ, Brown WM, Biffi A, Howard TD, Anderson CD, Brouwers HB, Valant V, Battey TW, Radmanesh F, Raffeld MR, Baedorf-Kassis S, Deka R, Woo JG, Martin LJ, Haverbusch M, Moomaw CJ, Sun G, Broderick JP, Flaherty ML, Martini SR, Kleindorfer DO, Kissela B, Comeau ME, Jagiella JM, Schmidt H, Freudenberger P, Pichler A, Enzinger C, Hansen BM, Norrving B, Jimenez-Conde J, Giralt-Steinhauer E, Elosua R, Cuadrado-Godia E, Soriano C, Roquer J, Kraft P, Ayres AM, Schwab K, McCauley JL, Pera J, Urbanik A, Rost NS, Goldstein JN, Viswanathan A, Stogerer EM, Tirschwell DL, Selim M, Brown DL, Silliman SL, Worrall BB, Meschia JF, Kidwell CS, Montaner J, Fernandez-Cadenas I, Delgado P, Malik R, Dichgans M, Greenberg SM, Rothwell PM, Lindgren A, Slowik A, Schmidt R, Langefeld CD, Rosand J, International Stroke Genetics C (2014) Meta-analysis of genome-wide association studies identifies 1q22 as a susceptibility locus for intracerebral hemorrhage. Am J Hum Genet 94:511–521CrossRefPubMedPubMedCentral
30.
go back to reference Xie C, Zhu R, Tian Y, Wang K (2017) Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open 7:e013983CrossRefPubMedPubMedCentral Xie C, Zhu R, Tian Y, Wang K (2017) Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open 7:e013983CrossRefPubMedPubMedCentral
31.
go back to reference Yavorska OO, Burgess S (2017) MendelianRandomization: an R package for performing Mendelian randomization analyses using summarized data. Int J Epidemiol 46:1734–1739CrossRefPubMedPubMedCentral Yavorska OO, Burgess S (2017) MendelianRandomization: an R package for performing Mendelian randomization analyses using summarized data. Int J Epidemiol 46:1734–1739CrossRefPubMedPubMedCentral
32.
go back to reference Yeboah J, Redline S, Johnson C, Tracy R, Ouyang P, Blumenthal RS, Burke GL, Herrington DM (2011) Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA. Atherosclerosis 219:963–968CrossRefPubMedPubMedCentral Yeboah J, Redline S, Johnson C, Tracy R, Ouyang P, Blumenthal RS, Burke GL, Herrington DM (2011) Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA. Atherosclerosis 219:963–968CrossRefPubMedPubMedCentral
33.
go back to reference Zaremba S, Albus L, Schuss P, Vatter H, Klockgether T, Guresir E (2019) Increased risk for subarachnoid hemorrhage in patients with sleep apnea. J Neurol 266:1351–1357CrossRefPubMed Zaremba S, Albus L, Schuss P, Vatter H, Klockgether T, Guresir E (2019) Increased risk for subarachnoid hemorrhage in patients with sleep apnea. J Neurol 266:1351–1357CrossRefPubMed
Metadata
Title
Sleep-disordered breathing-related symptoms and risk of stroke: cohort study and Mendelian randomization analysis
Authors
Olga E. Titova
Shuai Yuan
John A. Baron
Eva Lindberg
Karl Michaëlsson
Susanna C. Larsson
Publication date
01-05-2022
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 5/2022
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-021-10824-y

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