Abstract
Obstructive sleep apnea (OSA), the most common sleep disorder, affects nearly 1 billion people worldwide. Moreover, because most cases of OSA remain undiagnosed and untreated, affected individuals are at risk of serious complications, including ischemic stroke, cardiovascular disease, and cognitive decline. Although OSA is a well-established risk factor for cerebrovascular disease, particularly ischemic stroke, whether it might be an independent risk factor for the development, expansion, and rupture of cerebral aneurysms remains unclear. Whereas the pathology of a dissecting cerebral aneurysm differs from that of true cerebral aneurysm, also commonly referred to as saccular or berry aneurysm, the vascular damage caused by OSA is believed to contribute to weakening of the blood vessel walls, thereby increasing the risk of expansion and rupture of both types of aneurysms.
Here, we describe the case of a 57-year-old woman with class III obesity, a history of snoring, witnessed apnea during sleep, fatigue, and excessive daytime sleepiness for several years prior, who presented to the emergency department with diffuse subarachnoid hemorrhage (SAH) secondary to a ruptured dissecting aneurysm of the vertebral artery. The patient underwent endovascular embolization of this dissecting aneurysm, with subsequent significant clinical neurological improvement. An outpatient work-up revealed severe OSA, which was treated with continuous positive airway pressure (CPAP) therapy with significant improvement in her symptoms.
Keywords
Obstructive sleep apnea, Cerebral aneurysm, Subarachnoid hemorrhage, Stroke, Cerebrovascular disease, Intracranial hemorrhage