Predictive Factors for Short-Term and Three-Month Outcomes in Patients with Obstructive Sleep Apnea and Anterior Circulation Stroke without Large Artery Occlusion

Li Zhang^1,2Yang Feng^1,2Bing-Chuan Xie^1,2Zheng-Qi Xie^1,2Di Wu^2*Xiao-Yun Liu^1,2*

• ¹The First Hospital of Hebei Medical University, Shijiazhuang, China
• ²Xuanwu Hospital Capital Medical University, Beijing, China

Background: Obstructive sleep apnea (OSA) has been recognized as a potential risk factor for stroke. Among the pathophysiological mechanisms involved in stroke, neuroinflammatory response has gained increasing attention. However, the influence of OSA and inflammation on stroke prognosis remains insufficiently clarified. Methods: A retrospective analysis was conducted using clinical data from patients diagnosed with acute ischemic stroke (AIS) due to non-Large Artery Occlusion (LAO) in anterior circulation who were admitted between May 2018 and October 2021. Patients were stratified based on documented pre-stroke history of OSA. Multiple linear regression was employed to examine associations among hematological parameters, vascular risk factors, and clinical outcomes of AIS. Results: No statistically significant differences were observed between the OSA and non-OSA groups in terms of National Institutes of Health Stroke Scale (NIHSS) scores at admission, modified Rankin Scale (mRS) scores at discharge, or mRS scores at the 3-month follow-up (all p > 0.05). However, the multiple linear regression analysis revealed that a pre-stroke history of OSA was significantly associated with lower discharge NIHSS scores (p = 0.005), lower discharge mRS scores (p = 0.001), and lower 3-month mRS scores (p = 0.004). Platelet distribution width (PDW) was positively associated with higher discharge mRS scores (p = 0.018) and 3-month mRS scores (p = 0.006). Elevated white blood cell (WBC) counts were positively associated with discharge NIHSS (p = 0.001), discharge mRS (p < 0.001), and 3-month mRS (p = 0.001). Conclusions: Lower WBC count and the presence of a pre-stroke OSA history may be associated with less severe stroke presentation and more favorable functional outcomes both at discharge and at 3 months post-stroke. Additionally, a lower PDW might associated with better short-term and 3-month outcomes. In cases of anterior circulation AIS without LAO, our findings did not reveal an association between pre-stroke history of OSA with increased stroke severity or poorer prognosis.