Correlation of Polysomnography and Drug-induced Sleep Endoscopy Findings in Evaluating Obstructive Sleep Apnea–Hypopnea Syndrome in Stroke and Transient Ischemic Attack Patients

Abstract Introduction: Obstructive sleep apnea–hypopnea syndrome (OSAHS) is a common sleep disorder characterized by recurrent episodes of apnea and hypopnea during sleep, leading to intermittent hypoxia, fragmented sleep, and excessive daytime sleepiness. It is increasingly recognized as an independent risk factor for cardiovascular and cerebrovascular diseases, including stroke. The underlying pathophysiology involves repetitive upper airway collapse, which may exacerbate neurological injury and increase the risk of recurrent vascular events. Polysomnography (PSG) is considered the gold standard for diagnosing OSAHS, whereas drug-induced sleep endoscopy (DISE) provides dynamic visualization of airway obstruction during sleep, enabling identification of specific obstruction sites for targeted therapeutic interventions. Methodology: This prospective observational study included 30 patients aged 30–80 years with a confirmed diagnosis of stroke or transient ischemic attack (TIA) and OSAHS based on PSG findings. Patients with severe stroke (as per the National Institutes of Health Stroke Scale), awake oxygen saturation (SpO 2 ) below 90% without supplemental oxygen, or those with tracheostomy were excluded. All participants underwent detailed clinical evaluation, neuroimaging, PSG, and DISE. Sedation during DISE was achieved using either dexmedetomidine or propofol. Airway obstruction was assessed using the velum, oropharynx, tongue base, and epiglottis (VOTE) classification system. Results: Obstruction was most frequently observed at the oropharynx (93.33%), followed by the velum (86.67%), tongue base (80%), and epiglottis (60%). Multilevel obstruction was present in 76.67% of patients. Statistical analysis revealed a significant association between multilevel obstruction and higher apnea–hypopnea index (AHI), elevated respiratory disturbance index (RDI), and lower minimum oxygen saturation on PSG. Discussion: The study highlights that stroke and TIA patients with OSAHS commonly exhibit multilevel airway obstruction. DISE, when combined with PSG, offers a comprehensive assessment of the pattern and severity of airway collapse. Identifying precise obstruction sites allows personalized treatment planning, which may help reduce the risk of recurrent stroke and improve overall patient outcomes. Larger multicentric studies are recommended to validate these findings and refine clinical management protocols.