Abstract WP280: Sleep Apnea Screening is Uncommon After Stroke

Abstract

Introduction: Sleep apnea (SA) predicts poor functional outcome and mortality after stroke. Minority populations, including Mexican Americans (MAs), have worse outcomes after stroke than non-Hispanic whites (NHWs) and tend to have poorer access to care. We therefore sought to (1) assess access to SA-related care among post-stroke patients within a population-based study without an academic medical center, and (2) to compare ethnic differences in access to SA-related care in the post-stroke period in MAs and NHWs. Methods: MA and NHWs with ischemic stroke or intracerebral hemorrhage in the Brain Attack Surveillance in Corpus Christi project between 2011-2015 were interviewed at approximately 90 days after stroke in reference to the post-stroke period. Questions included whether their clinical provider directly asked about (1) snoring or (2) daytime sleepiness, or (3) had offered polysomnography. Logistic regression was used to test the association between ethnicity and the three outcomes unadjusted and adjusted for potential confounders: age, sex, insurance status, primary care provider status (PCP), BMI, stroke type, NIHSS at stroke presentation, hypertension, diabetes, atrial fibrillation, hyperlipidemia, and current smoking. Results: Of the almost 1,000 respondents, 49% were male, 63% MA, 81% had hypertension, 48% had diabetes, and 10% did not have a PCP. Mean age was 69 (SD=12) and mean BMI was 30 (SD=6.8). MAs were younger, had a higher BMI, greater prevalence of hypertension, diabetes, never smoking, and lower prevalence of atrial fibrillation than NHWs. Of the 985 respondents to the symptom questions, 50 (5%) reported being directly queried about snoring and 86 (9%) reported being directly queried about sleepiness. Fifty-five of 981 (6%) reported having been offered polysomnography by their providers. No ethnic differences were found among the three outcomes in unadjusted or adjusted analyses. Conclusion: Screening for classic symptoms of SA and offers for formal testing of SA by clinical providers are rare by 90 days post-stroke, without ethnic differences. Provider education is needed to raise awareness about the very high prevalence of SA among stroke patients and its association with poor outcomes after stroke.