Abstract DP179: Sleep-Disordered Breathing May Modify Association of Thrombolysis with Stroke Outcomes After Ischemic Stroke

Introduction: Sleep-disordered breathing (SDB) is common after stroke and may modify response to thrombolytic therapy. We evaluated whether SDB alters the effectiveness of tPA on post-stroke outcomes. Methods: Eligible participants with ischemic stroke from 2010-2019 enrolled in the Brain Attack Surveillance in Corpus Christi (BASIC) study were offered a home sleep apnea test (ApneaLink Plus). SDB was defined by a respiratory event index ≥10, soon after stroke (median 13 days [IQR: 6, 21]). Treatment with IV thrombolysis (tPA) was abstracted from the medical record. Linear models using propensity score-adjustment were used to estimate the associations of tPA on 90-day outcomes including: activities of daily living [ADLs]/instrumental ADLs (range 1-4, higher score=greater disability), National Institutes of Health Stroke Scale [NIHSS], (range 0-42, higher score=worse severity), abbreviated Stroke-Specific Quality of Life scale [SS-QOL] (range 1-5, higher score=better quality of life) and Modified Mini-Mental State Examination [3MSE] (range 0–100, higher scores=better cognition). Propensity scores of tPA receipt were estimated from a logistic model including demographics, education, insurance, risk factors, BMI, pre-stroke disability and cognition, days from stroke to sleep apnea test, and SDB-stroke severity interactions as predictors; analyses were stratified by SDB status, with an interaction term to test whether the effect of tPA differed by SDB status. Results: Of the 1,034 participants included, individuals with vs without SDB were more likely to be male, of Mexican American ethnicity, and had higher frequency of hypertension, diabetes, and obesity (all p < 0.01, Table 1). In adjusted analyses, among participants with SDB, tPA was associated with significantly better outcomes including lower disability, improved neurological outcome, and better quality of life (Table 2). Among participants without SDB, tPA associations were small and not statistically significant (Table 2). Interaction estimates trended toward greater benefit of tPA among those with SDB, particularly for functional and quality-of-life outcomes, although these did not reach significance (Table 2). Conclusions: SDB is linked to greater vascular risk burden and ethnic disparities after stroke. IV tPA may confer greater functional and quality-of-life benefits among patients with vs without SDB. Findings support further study of SDB as a potential modifier of thrombolysis outcomes.