Distinctive Features of Obstructive Sleep Apnea in Chinese Patients With Acute Cerebral Infarction: A Prospective Observational Study.

BACKGROUND: Obstructive sleep apnea (OSA) is a modifiable risk factor that benefits from timely detection and treatment to improve poststroke outcomes, yet ethnic-specific features and practical screening strategies remain undercharacterized. We evaluated OSA prevalence, its association with neurocognitive function, and screening performance in Chinese patients with acute cerebral infarction. METHODS: In this prospective cohort, 183 consecutive Han Chinese inpatients with acute cerebral infarction underwent home sleep apnea testing within 2 weeks of onset. Moderate to severe OSA was defined as an apnea-hypopnea index ≥15 events/h. Neurocognitive function was assessed by Mini-Mental State Examination and National Institutes of Health Stroke Scale. The diagnostic performance of the STOP-Bang questionnaire, including sensitivity, specificity, positive predictive value, and negative predictive value, was evaluated for identifying moderate to severe OSA. RESULTS: OSA prevalence was 79.2%, with 37.7% moderate to severe. Cognitive impairment (Mini-Mental State Examination <23) was less frequent in patients without OSA than patients with OSA (15.8% versus 31.3%-40.8%, P=0.048). Sex-stratified analyses showed higher cognitive impairment burden in women comparing non-OSA versus mild OSA (P=0.040), with no parallel association observed in men (all P=0.400). STOP-Bang had limited discrimination (area under the receiver operating characteristic curve, 0.72), with high sensitivity (88.4%) but low specificity (39.5%). CONCLUSIONS: Chinese patients with acute cerebral infarction have a high OSA burden. Sex-stratified results suggest potential female-specific vulnerability to OSA-related cognitive impairment, warranting larger cohorts. Given limited specificity and triage value of STOP-Bang, objective sleep apnea evaluation should be performed whenever feasible in this population. REGISTRATION: URL: https://www.chictr.org.cn/. Identifier: ChiCTR2000038312.