Cerebral Small Vessel Disease and Sleep-Disordered Breathing in Patients with Acute Intracerebral Haemorrhage: A Prospective Two-Centre Observational Study

Abstract Background Intracerebral haemorrhage (ICH) is the second most common stroke subtype and carries high mortality and disability. Cerebral small vessel disease (cSVD) and sleep-disordered breathing (SDB) are mechanistically linked and both implicated in ICH pathogenesis, yet their relationship has not been characterised in the acute ICH setting using modern imaging criteria. Methods Consecutive patients with CT-confirmed acute ICH were prospectively enrolled at two neurology centres. In all 118 patients, cSVD was assessed using the Fazekas score on brain CT. A predefined subgroup of 26 clinically stable patients with atypical ICH or inconclusive CT findings underwent MRI with cSVD assessment using STRIVE-2 criteria (total SVD score). Overnight pulse oximetry (WristOx2) was performed within 7 days of onset. Results SDB was present in 89.0% of the full cohort. Significant cSVD on CT (Fazekas ≥ 2) was found in 64.4%; SDB prevalence was similar between significant and non-significant cSVD groups (89.5% vs. 88.1%; p = 0.819). In the MRI subgroup ( n = 26), significant cSVD (SVD score ≥ 2) was observed in 73.1%. SDB was present in all 19 patients (100%) with significant cSVD vs. 5/7 (71.4%) with non-significant cSVD ( p = 0.015). Conclusion SDB and cSVD are common in acute ICH. The full CT cohort showed no association between SDB and CT-visible white matter disease. A selected MRI subgroup suggested a possible association between SDB and a higher MRI cSVD burden; however, this finding requires confirmation in a systematically imaged, adequately powered cohort using formal sleep testing.