Abstract P205: Fair Agreement Between Stroke Patients and Family Members for Ascertaining Pre-Stroke Risk of Sleep Apnea

Abstract

Background Obstructive sleep apnea is a risk factor for ischemic stroke and may play a role in post-stroke outcomes. Ascertaining self-reported information about pre-stroke sleep apnea risk in the acute stroke period is challenging as many stroke patients have deficits that hinder communication. We examined agreement between stroke patients and family members (proxy) with respect to pre-stroke risk of sleep apnea and hypothesized that agreement would be good. Methods Patient-proxy pairs (n=38) were interviewed as part of the Brain Attack Surveillance in Corpus Christi Project from May 2010 - April 2011. The Berlin Questionnaire was used to measure high risk of sleep apnea defined as at least two of the following: 1) snoring behaviors and witnessed apneas 2) daytime sleepiness and 3) hypertension or obesity. Patient-proxy agreement was assessed using a kappa coefficient. Results Average patient age was 70 (SD=12 years), 68% (n=26) were Mexican American and 32% (n=12) non-Hispanic white. An equal number of male and female patients participated (n=19), and average NIH Stroke Scale value at admission was 5.5 (SD = 6.4). Proxies were spouses (n=24) or children (n=14). Proxies had known patients for an average of 40 years (SD=15) and spoke with the patient daily (n=37) or weekly (n=1). Forty percent of patients (n=15) self-identified as high risk for sleep apnea and 52% of proxies (n=20) identified patients as high risk. Patient-proxy agreement for high risk of sleep apnea was fair (kappa=0.43; table 1 ) and was the same for both spouses and children. Conclusions Proxies can be used to assess pre-stroke risk of sleep apnea when a stroke patient is unable to participate as agreement for high risk of sleep apnea was fair. Proxies reported a high risk for sleep apnea with greater frequency than patients, suggesting there may be differences in observation of specific high-risk characteristics between proxies and patients. Table 1. Patient-Proxy Agreement for Risk of Sleep Apnea (n=38) Patient Risk Assessment Proxy Risk Assessment Total Low High Low 15 8 23 High 3 12 15 Total 18 20 38