SLEEP-DISORDERED BREATHING ASSESSED BY CARDIOPULMONARY COUPLING PREDICTS ONE-YEAR OUTCOMES AFTER ISCHEMIC STROKE

초록

Background Cardiopulmonary coupling (CPC) analysis, derived from Holter-based ECG signals, characterizes sleep stability and infers sleep-disordered breathing (SDB) patterns. Previous studies demonstrated narrow band (NB) coupling in CPC, predicts poor 3-month functional outcomes after ischemic stroke. We aimed to investigate whether SDB defined by CPC analysis in the acute phase of ischemic stroke predicts adverse 1-year clinical outcomes. Methods We retrospectively analyzed consecutive patients with acute ischemic stroke who underwent 24-hour Holter monitoring within 30 days of onset. CPC analysis was performed on Holter-derived ECG during putative sleep periods using validated spectrographic methods. Patients with spectrographically detectable NB coupling were classified as the NB group, and those without as the non-NB group. The primary endpoint was recurrent ischemic stroke at 1 year. The secondary endpoint was major adverse cerebrovascular and cardiovascular events (MACE: recurrent ischemic stroke, transient ischemic attack, and all-cause mortality). Multivariable Cox regression and propensity-score matched analyses were performed. Results Among 666 patients (mean age 64.1±12.7 years, 64% male), NB coupling was detected in 30.8%. At 1 year, recurrent ischemic stroke occurred more frequently in the NB group (8.3% vs 1.4%; log-rank p<0.001). The cumulative incidence of MACE was also significantly higher in the NB group (14.9% vs 3.0%; p<0.001). In multivariable analysis, NB remained an independent predictor of recurrent ischemic stroke (HRadj 4.63, 95% CI 1.66-12.8; p=0.003) and MACE (HRadj 3.91, 95% CI 1.63-09.41; p=0.002), even after propensity-score adjustment. Conclusion CPC-derived SDB assessed by Holter monitoring at the early phase of ischemic stroke independently predicted adverse 1-year outcomes, including recurrent stroke and MACE. This simple, non-invasive approach may offer a practical tool for risk stratification and secondary prevention in acute stroke patients.