Association between the high risk for obstructive sleep apnea and intracranial carotid artery calcification in patients with acute ischemic stroke



Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Furthermore, intracranial carotid artery calcification (ICAC) is a marker for subclinical atherosclerosis and future cardiovascular events. We investigated the association between the high risk for OSA and ICAC in patients with acute ischemic stroke.


We retrospectively investigated 73 patients who were admitted to the hospital with acute ischemic stroke in the internal carotid artery (ICA) territory due to large-artery atherosclerosis. The risk for OSA was assessed using the Berlin Questionnaire, and patients were classified into low-risk (LR-OSA) and high-risk groups (HR-OSA). We compared the burden of ICAC between the two groups. Univariable and multivariable analyses were conducted to investigate the association of high risk for OSA with the presence of calcium in intracranial ICA.


The HR-OSA group of 35 patients (48%) was significantly older and had a higher rate of hypertension and diabetes mellitus than the LR-OSA group. The HR-OSA group had more frequent ICAC (92% vs. 63%, p < 0.001), higher Agatston score (162.0 vs. 8.5, p < 0.001), and greater total volume of ICAC (261.2 mm3 vs. 20.1 mm3, p < 0.001) in the intracranial ICA. Presence of calcium in symptomatic intracranial ICA was positively correlated with age (odds ratio, OR, 1.432; 95% confidence interval, CI, 1.098–1.868) and HR-OSA (OR, 18.272; 95% CI, 0.500–668.401) in multivariable logistic regression analysis.


This study showed that the presence of calcium in symptomatic intracranial ICA was related to high risk for OSA in patients with acute ischemic stroke.

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Availability of data and material

We deposited the raw data. However, out data cannot be used without approval of Institutional Review Board of our hospital for ethical or legal reasons.


This work was supported by the Soonchunhyang University Research Fund.

Author information




H.G.W. and T.J.S.: substantial contribution to conception, design, acquisition of data, data analysis and interpretation, and writing the manuscript. J.S.J. and S.W.O.: conception, design, data analysis, writing of paper, and final approval of the version to be published. S.C.L. and J.M.S.: conception, design, data acquisition, revising of paper, and final approval of the version to be published. K.I.Y.: conception, design, data analysis, revising of paper, and final approval of the version to be published. This manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work.

Corresponding author

Correspondence to Kwang Ik Yang.

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The authors declare that they have no competing interests.

Ethical approval

The institutional review board of Soonchunhyang University Cheonan Hospital (SCHCA 2018-07-027-001) approved this retrospective study.

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The institutional review board approved this retrospective study, and the requirement for informed consent was waived.

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Woo, H.G., Song, T., Jung, J.S. et al. Association between the high risk for obstructive sleep apnea and intracranial carotid artery calcification in patients with acute ischemic stroke. Sleep Breath (2020).

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  • Obstructive sleep apnea
  • Intracranial carotid artery calcification
  • Berlin questionnaire
  • Stroke