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Background <p>Obstructive sleep apnea (OSA) affects two-thirds of acute ischemic stroke (AIS) patients and is linked to poor neurological recovery and recurrent stroke. Current OSA screening tools (e.g., STOP-BANG) are limited by subjectivity and impracticality in acute stroke settings. We evaluated the predictive value of upper airway dimensions measured on routine brain MRI (Magnetic Resonance Imaging) - a novel, objective strategy - for screening severe OSA in AIS patients.</p> Methods <p>In this prospective single-center study (April–October 2024), 103 adults with AIS underwent routine brain MRI. Retropalatal and combined retropalatal-retroglossal pharyngeal length (CRR) were measured on sagittal T1-weighted sequences. OSA severity was confirmed via cardiorespiratory polygraphy. The diagnostic accuracy of these MRI-derived measurements for screening severe OSA was compared to the STOP-BANG questionnaire.</p> Results <p>Participants (mean age 59.6 ± 11.2 years; 71.8% male) had mild-moderate stroke severity (median NIHSS 3 [IQR 2–4]) and mean BMI 24.1 ± 3.1&#xa0;kg/m². CRR was significantly longer in severe OSA versus non-severe OSA (66.6 ± 8.9&#xa0;mm vs. 62.5 ± 8.1&#xa0;mm, <i>p</i> = 0.048). CRR demonstrated superior discriminative accuracy for severe OSA (AUC = 0.70, 95% CI: 0.61–0.78) compared to STOP-BANG ≥ 3 (AUC = 0.57, 95% CI: 0.48–0.65). Using cutoff ≥62&#xa0;mm, CRR achieved 91% sensitivity and 49% specificity, outperforming STOP-BANG ≥ 3 (sensitivity = 90%, specificity = 24%).</p> Conclusions <p>Opportunistic measurement of CRR on routine brain MRI is a rapid, non-invasive screening tool for severe OSA in AIS, leveraging existing neuroimaging data without added costs or patient burden. It’s high sensitivity minimizes missed diagnoses, addressing a critical gap in acute stroke care.</p>

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Opportunistic pharyngeal length measurement on routine brain MRI: A novel screening tool for severe obstructive sleep apnea in acute stroke

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Tho Dinh Phung,
  • Giap Van Vu,
  • Chung Thi Phan,
  • Huyen Thi Nguyen,
  • Khanh Ba Le,
  • Hoai Thi Thu Nguyen

摘要

Background

Obstructive sleep apnea (OSA) affects two-thirds of acute ischemic stroke (AIS) patients and is linked to poor neurological recovery and recurrent stroke. Current OSA screening tools (e.g., STOP-BANG) are limited by subjectivity and impracticality in acute stroke settings. We evaluated the predictive value of upper airway dimensions measured on routine brain MRI (Magnetic Resonance Imaging) - a novel, objective strategy - for screening severe OSA in AIS patients.

Methods

In this prospective single-center study (April–October 2024), 103 adults with AIS underwent routine brain MRI. Retropalatal and combined retropalatal-retroglossal pharyngeal length (CRR) were measured on sagittal T1-weighted sequences. OSA severity was confirmed via cardiorespiratory polygraphy. The diagnostic accuracy of these MRI-derived measurements for screening severe OSA was compared to the STOP-BANG questionnaire.

Results

Participants (mean age 59.6 ± 11.2 years; 71.8% male) had mild-moderate stroke severity (median NIHSS 3 [IQR 2–4]) and mean BMI 24.1 ± 3.1 kg/m². CRR was significantly longer in severe OSA versus non-severe OSA (66.6 ± 8.9 mm vs. 62.5 ± 8.1 mm, p = 0.048). CRR demonstrated superior discriminative accuracy for severe OSA (AUC = 0.70, 95% CI: 0.61–0.78) compared to STOP-BANG ≥ 3 (AUC = 0.57, 95% CI: 0.48–0.65). Using cutoff ≥62 mm, CRR achieved 91% sensitivity and 49% specificity, outperforming STOP-BANG ≥ 3 (sensitivity = 90%, specificity = 24%).

Conclusions

Opportunistic measurement of CRR on routine brain MRI is a rapid, non-invasive screening tool for severe OSA in AIS, leveraging existing neuroimaging data without added costs or patient burden. It’s high sensitivity minimizes missed diagnoses, addressing a critical gap in acute stroke care.