Depression After Ischemic Stroke Linked With OSA Severity, Study Finds

Severity of obstructive sleep apnea in patients was shown to be positively associated with a 3-month depression after ischemic stroke, according to study findings.

Severity of obstructive sleep apnea (OSA) in patients was shown to be positively associated with 3-month depression following ischemic stroke (PSD, or post-stroke depression), according to study findings published in the Journal of Stroke and Cerebrovascular Diseases.

As indicated in a prior study, OSA is found in over 60% of patients who have had ischemic stroke, and it is listed as an independent stroke risk factor in large epidemiology studies and the Canadian Stroke Prevention Guidelines. As the researchers note, OSA serves not only as a common contributor to ischemic stroke, but as a frequent comorbidity as well. Because nearly 10% of men and a fifth of women were shown to experience PSD, the significance of OSA, which is also linked with depression, may further intensify these effects.

To examine the correlation between OSA severity and PSD in patients, the study authors recruited 265 patients with symptom onset less than 14 days after ischemic stroke and who underwent polysomnography examination for diagnosis of OSA during hospitalization. The study was conducted from March 2017 to December 2018, with PSD being identified using the Chinese version of the Structured Clinical Interview for DSM-IV at baseline and at 3 months.

Of the study cohort, 18.1% (n = 48) had no OSA, 32.1% (n = 85) had mild OSA, 20.4% (n = 54) had moderate OSA, and 29.4% (n = 78) had severe OSA. Additionally, 63 patients had PSD diagnosed at baseline (23.8%) and 86 after 3 months (32.5%). The researchers performed logistic regression analyses to assess the association between OSA severity and PSD.

In findings from the univariate analysis, reduced OSA severity was found to be correlated with PSD at 3 months (P = .003), but not at admission (P = .373). Moreover, the multivariable analysis found that compared with those without OSA, patients with severe OSA had a significantly increased risk of PSD at 3 months (odds ratio, 4.04; 95% CI, 1.38-9.62; P = .036).

After performing a multiple-adjusted spline regression model, the researchers highlight that a dose-response relationship was further shown with the apnea-hypopnea index and 3-month PSD significantly linked (P for linearity < .001). As data points to the positive association between OSA severity and 3-month PSD in patients who had ischemic stroke, timely interventions to ameliorate these comorbidities may be warranted, due to the suggested lack of a likelihood of survival as symptoms of depression increase.


Li C, Liu Y, Fan Q, et al. Association between obstructive sleep apnea and risk of post-stroke depression: a hospital-based study in ischemic stroke patients. J Stroke Cerebrovasc Dis. Published online May 13, 2020. doi:10.1016/j.jstrokecerebrovasdis.2020.104876