Obstructive Sleep Apnea in a Young Stroke: A Case Report

Stroke in young adults is relatively uncommon, and the underlying etiology often differs from that observed in older populations. Obstructive sleep apnea (OSA) is increasingly recognized as an independent and underdiagnosed risk factor for cerebrovascular disease. We report the case of a 27-year-old previously healthy male who presented with acute right-sided weakness and slurred speech. Neuroimaging revealed an acute left basal ganglia infarct consistent with a lacunar stroke, and computed tomography angiography demonstrated no evidence of large-vessel occlusion. The patient received intravenous alteplase within two hours of symptom onset according to institutional stroke protocol. During hospitalization, he was observed to have loud snoring, excessive daytime somnolence, nasal speech, and grade 3 tonsillar hypertrophy, raising suspicion of obstructive sleep apnea as a contributing factor. Laboratory investigations revealed elevated hemoglobin and hematocrit levels suggestive of secondary polycythemia. The patient was treated with physiotherapy and secondary stroke prevention therapy and was referred for further evaluation of suspected sleep-disordered breathing. This case highlights the importance of considering obstructive sleep apnea as a potential contributor to ischemic stroke in young individuals without traditional vascular risk factors.