ABSTRACT NUMBER: ESOC2026A979 SLEEP APNEA AS AN INDEPENDENT PREDICTOR OF EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE: IMPACT OF SEVERITY THRESHOLDS

Abstract Background and aims Early neurological deterioration (END) is a common complication after acute ischemic stroke. Sleep apnea is highly prevalent in the acute phase and may contribute to END through recurrent respiratory events and intermittent hypoxemia. Whether specific severity thresholds of sleep apnea provide superior prognostic value for END compared with a simple diagnosis remains unclear. Methods We conducted a prospective observational study of 125 acute ischemic stroke patients. Sleep apnea was assessed using bedside respiratory polygraphy. END was defined as a ≥ 2-point increase in National Institutes of Health Stroke Scale (NIHSS) score within 72 hours of admission. Associations between sleep apnea and END were evaluated using univariate analysis and multivariable logistic regression adjusted for baseline NIHSS, diabetes, intracranial arterial stenosis/occlusion, and hemorrhagic transformation. Receiver operating characteristic (ROC) analysis identified optimal prognostic cutoffs for apnea–hypopnea index (AHI) and oxygen desaturation index (ODI). Results Median baseline NIHSS was 3 (IQR 2–4); 68.8% were male. Sleep apnea was present in 66.4%; END occurred in 15.2%. Sleep apnea was independently associated with END (adjusted OR 6.30, 95% CI 1.29–30.80; p=0.023). ROC analysis identified optimal cutoffs of approximately 15 events/h for AHI and ODI, consistent with moderate-to-severe sleep apnea and significant nocturnal hypoxic burden. Conclusions Sleep apnea independently predicts END after acute ischemic stroke. Prognostic discrimination is optimized at thresholds corresponding to moderate-to-severe sleep apnea, supporting early assessment of sleep apnea severity and hypoxic burden in the acute stroke setting. Which may help identify patients most likely to benefit from targeted respiratory interventions. Conflict of interest Tho Phung: nothing to disclose Hoai-Thi-Thu Nguyen: nothing to disclose Giap Vu: nothing to disclose