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London, United Kingdom 2013 7 Intracerebral/subarachnoid haemorrhage and venous diseases 11:30 - 11:40 Population-based case-control study of premorbid symptoms of obstructive sleep apnoea in pathological and aetiological subtypes of TIA and stroke L.E. Binney1, Z. Mehta2, P.M. Rothwell3 Stroke Prevention Unit, Department of Clinical Neurosciences, University of Oxford, Ox-ford, UNITED KINGDOM1,Stroke Prevention Unit, Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM2, Stroke Prevention Unit, Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM3 BACKGROUND: Patients with obstructive sleep apnoea (OSA) have abrupt surges in blood pressure (BP) with each apnoeic episode, which might have different effects on risks of intrace-rebal and subarachnoid haemorrhage versus ischaemic stroke and on different aetiological sub-types of TIA and ischaemic stroke. Men with OSA have indeed been shown to be at increased risk of stroke, but there are few data on differences between ischaemic and haemorrhagic stroke and between aetiological subtypes. METHODS: We did a case-control study of sleep symptoms preceding TIA and stroke in a population-based study (Oxford Vascular Study) with community controls, using a validated sleep questionnaire covering daytime sleepiness, snoring and witnessed apnoeas. Analyses were stratified by pathological subtype of events (ischaemic versus haemorrhagic - intracerebral or subarachnoid), events present on waking, and by TOAST subtype for ischaemic events. RESULTS: 551 patients with stroke and 341 with TIA completed the interview (76% within 7-days of their acute event) along with 423 population controls. TIA and ischaemic stroke were associated with excessive premorbid daytime sleepiness (age/sex adjusted OR: 2.9, 95% CI 2.0- 4.2, p<0.0001, vs controls), but the association was strongest in men with haemorrhagic stroke (OR: 5.2, 1.9-14, p=0.002). Neither frequent snoring nor apnoeas prior to the event were asso-ciated with TIA or ischaemic stroke (separately or together), but frequent snoring was associ-ated with haemorrhagic stroke (OR: 4.0, 1.5-11, p=0.007) in men. For ischaemic events results were similar by TOAST subtype and for events present on waking. The proportion of events with onset during sleep did not differ significantly between ischaemic and haemorrhagic stroke. CONCLUSIONS: Our findings suggest that the association between markers of OSA and risk of stroke might differ between ischaemic and haemorrhagic events. Future studies should strati-fy analyses by pathological subtype. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 131 6 Intracerebral/subarachnoid haemorrhage and venous diseases 11:20 - 11:30 THE RISK OF RUPTURE OF BRAIN ARTERIOVENOUS MALFORMATIONS DURING PREGNANCY, DELIVERY, AND THE PUERPERIUM: A CASE-CROSS-OVER STUDY J. van Beijnum1, T. Wilkinson2, J.G. van der Bom3, A. Algra4, R. van den Berg5, W.P. Vander-top6, P.A. Brouwer7, G.J.E. Rinkel8, L.J. Kappelle9, R.A. Salman10, C.J.M. Klijn11 UMCU, LUMC, Utrecht, THE NETHERLANDS1,Division of Clinical Neurosciences, Cen-tre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UNITED KINGDOM2, LUMC, Leiden, THE NETHERLANDS3, UMCU, Utrecht Stroke Center, Utrecht, THE NETH-ERLANDS4, Neurosurgical Center Amsterdam, Amsterdam, THE NETHERLANDS5, Neu-rosurgical Center Amsterdam, Amsterdam, THE NETHERLANDS6, LUMC, Leiden, THE NETHERLANDS7, UMCU, Utrecht Stroke Center, Utrecht, THE NETHERLANDS8, UMCU, Utrecht Stroke Center, Utrecht, THE NETHERLANDS9, Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Ed-inburgh, Edinburgh, UNITED KINGDOM10, UMCU, Utrecht Stroke Center, Utrecht, THE NETHERLANDS11 Background – It is unclear whether the risk of bleeding from brain arteriovenous malformations (BAVMs) is higher during pregnancy, delivery and the puerperium. We compared the risk of haemorrhage from BAVMs for women during this period with their risk of haemorrhage out-side this period during their fertile lives. Methods – We included all women with ruptured BAVMs between 16 and 42 years of age from a database of patients diagnosed with BAVMs in four Dutch university hospitals (n=96) and from the population-based Scottish Audit of Intracranial Vascular Malformations (n=46). We estimated the relative risk (RR) of BAVM rupture during women’s fertile lives until first BAVM haemorrhage by comparing the haemorrhage rate during exposed time (pregnancy, delivery and puerperium; nine months in total) to the rate during non-exposed time, using a case-crossover (CCO) design. Results – Of a total of 142 women, 21 experienced their haemorrhage while pregnant (20 wom-en) or in the puerperium (1 woman). None of the haemorrhages occurred during delivery. The median age at BAVM haemorrhage was 29 years. They gave birth to their first child at median age of 25 years. Twenty-one haemorrhages occurred during a total of 92 years at risk (23% per year exposed), and 121 haemorrhages occurred during 1,865 years during non-exposed time (6.5% per year exposed). The RR of BAVM rupture during pregnancy, delivery, and the puer-perium according to the CCO method was 4.2 (95% CI, 2.5 to 7.1). Conclusion – The risk of BAVM rupture is increased during pregnancy, delivery, and the puer-perium, primarily due to an increased risk of haemorrhage during pregnancy.


Karger_ESC London_2013
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