Abstract Number: Esoc2026a768 Sleep Apnea–related Hypoxemia Predicts Disability After Acute Ischemic Stroke Better Than the Apnea–hypopnea Index

Background and aims Sleep apnea affects two-thirds of acute ischemic stroke (AIS) patients, but its prognostic utility remains debated. This study evaluates nocturnal hypoxemia metrics and traditional sleep apneic indices as predictors of post-stroke functional outcomes. Methods This prospective cohort study enrolled patients with AIS at the Stroke Center of Bach Mai Hospital between April and October 2024. Participants underwent overnight cardio-respiratory polygraphy. Functional outcomes (modified Rankin Scale [mRS]) were evaluated at 3 months. Multivariate logistic regression analysis identified predictors of unfavorable outcomes (mRS >1). Results Of the 125 AIS patients enrolled (median National Institutes of Health Stroke Scale [NIHSS] score 3, interquartile range 2–4), 66.4% were diagnosed with sleep apnea (apnea-hy-popnea index [AHI] >10). At 3-month follow-up, univariate analysis revealed that younger age, absence of diabetes, lower baseline NIHSS, absence of early neurological deterioration (END), lower AHI, reduced oxygen desaturation index (ODI), higher mean SpO2, and shorter percentage of time with SpO2 <90% were significantly associated with favorable functional outcomes (all p<0.05). In multivariate logistic regression, NIHSS, END, diabetes, ODI, percentage of time with SpO2 <90%, and mean SpO2 were independent predictors of unfavorable outcomes (all p<0.05). Notably, AHI did not show a significant association with outcomes (p>0.05). Conclusions In acute ischemic stroke, baseline NIHSS, early neurological deterioration, diabetes, and nocturnal hypoxemia—but not the apnea–hypopnea index—independently predict 3-month functional disability. Measures of hypoxemia burden, particularly ODI and the duration of oxygen desaturation, provide superior prognostic information and may represent actionable targets for optimizing post-stroke management. Conflict of interest Tho Phung: nothing to disclose Hoai-Thi-Thu Nguyen: nothing to disclose Giap Vu: nothing to disclose Duy-Ton Mai: nothing to disclose Huyen Bui: nothing to disclose Vien Tran: nothing to disclose Luu Dao: nothing to disclose Minh Nguyen: nothing to disclose