Unattended Hospital and Home Sleep Apnea Testing Following Cerebrovascular Events

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 1; pp. 143 - 149
• Main Authors: Boulos, Mark I., MD, MSc, Elias, Sara, MD, Wan, Anthony, BHSc, Im, James, BSc, Frankul, Fadi, MD, Atalla, Mina, BSc, Black, Sandra E., MD, Basile, Vincenzo S., MD, Sundaram, Arun, MD, Hopyan, Julia J., MD, Boyle, Karl, MB, MSc, Gladstone, David J., MD, PhD, Swartz, Richard H., MD, PhD, Murray, Brian J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2017
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Continuous Positive Airway Pressure - methods; feasibility; Female; Home Care Services; Home sleep apnea testing; Hospitals - statistics & numerical data; Humans; Ischemic Attack, Transient - complications; Male; Middle Aged; Neurology; obstructive sleep apnea; Outcome Assessment (Health Care); Polysomnography; portable sleep monitoring; Prospective Studies; Retrospective Studies; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - etiology; stroke; Stroke - complications; transient ischemic attack; obstructive sleep apnea; feasibility; portable sleep monitoring; transient ischemic attack; Home sleep apnea testing; stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.001

Background Home sleep apnea testing (HSAT) is an alternative to polysomnography for the detection of obstructive sleep apnea (OSA). We assessed the feasibility of HSAT as an unattended screening tool for patients with a stroke or transient ischemic attack (TIA). Aims The primary outcome was the feasibility of unattended HSAT, as defined by analyzability of the data. Secondary outcomes included determining (1) predictors of obtaining nonanalyzable sleep data and (2) time to OSA detection and continuous positive airway pressure (CPAP) initiation. Methods In this single-center prospective observational study, inpatients or outpatients who had sustained a stroke or TIA were screened for OSA using the ApneaLink Plus ambulatory sleep monitor in their home or hospital room. Results There were 102 patients who completed unattended sleep monitoring. Mean age was 68.7 ± 13.7 years, 55.9% were male, 57.8% were outpatients, and 77.5% had a stroke (22.5% with TIA). Eighty-two (80.4%) patients obtained four or more hours of analyzable sleep data. Functional dependence (defined as a modified Rankin Scale of >2) and elevated body mass index were independently associated with obtaining nonanalyzable data. OSA was detected in 63.4% (52 of 82) of patients and, of those, 34 of 52 (65.4%) initiated CPAP therapy. The mean time from study recruitment to HSAT was 1.7 days (median: 1, interquartile range [IQR]: 2) and CPAP was initiated on average within 62.7 days of recruitment (median: 53, IQR: 30). Conclusions Unattended HSAT can be feasibly implemented after stroke or TIA. This method facilitates rapid diagnosis and management of OSA in both the outpatient and inpatient settings.