Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA.

Benjamin K Petrie,Julie Shulman,Thanh N Nguyen,Yelena G Pyatkevich,Helena Lau,Sanford Auerbach,Saleh Abbas,Tatiana Filina,Hesham Masoud,Tudor Sturzoiu,Jose Rafael Romero,Judith Clark,Hugo J Aparicio

doi:10.3390/jcm10163568

Abstract

Sleep disordered breathing (SDB) is highly prevalent, but frequently unrecognized among stroke patients. Polysomnography (PSG) is difficult to perform soon after a stroke. We evaluated the use of screening questionnaires and portable sleep testing (PST) for patients with acute stroke, subarachnoid hemorrhage, or transient ischemic attack to expedite SDB diagnosis and management. We performed a single-center retrospective analysis of a quality improvement study on SDB screening of consecutive daytime, weekday, adult admissions to a stroke unit. We excluded patients who were unable to communicate and lacked available family members. Patients were screened with the Epworth Sleepiness Scale, Berlin Questionnaire, and STOP-BANG Questionnaire and underwent overnight PST and/or outpatient PSG. The 4-item STOP Questionnaire was derived from STOP-BANG for a secondary analysis. We compared the sensitivity and specificity of the questionnaires for the diagnosis of at least mild SDB (apnea hypopnea index (AHI) ≥5) on PST and correlated AHI measurements between PST and PSG using the Spearman correlation. Out of sixty-eight patients included in the study, 54 (80%) were diagnosed with SDB. Only one (1.5%) had a previous SDB diagnosis. Thirty-three patients completed all questionnaires and a PST. The STOP-BANG questionnaire had the highest sensitivity for at least mild SDB (0.81, 95% CI (confidence interval): 0.65–0.92) but a low specificity (0.33, 95% CI 0.10, 0.65). The discrimination of all questionnaires was overall poor (C statistic range 0.502–0.640). There was a strong correlation (r = 0.71) between the AHI results estimated using PST and outpatient PSG among 28 patients. The 4-item STOP Questionnaire was the easiest to administer and had a comparable or better sensitivity than the other questionnaires. Inpatient PSTs were useful for screening in the acute setting to facilitate an early diagnosis of SDB and to establish further outpatient evaluations with sleep medicine.

Highlights

Sleep disordered breathing (SDB) is an upper airway dysfunction that results in the transient cessation of breathing during sleep and is diagnosed with polysomnography (PSG)
We studied the use of three common screening questionnaires (Epworth Sleepiness Scale (ESS), the Berlin Questionnaire (BQ), and STOP Questionnaire (STOP)-BANG (SB)) and an overnight portable sleep test (PST) device to diagnose SDB among inpatients with acute stroke, subarachnoid hemorrhage, and transient ischemic attack (TIA) at our medical center
We observed a high prevalence of at least mild SDB (80%) in our diverse population of acute stroke, subarachnoid hemorrhage and TIA patients, implementing the use of a home sleep apnea testing device for early diagnosis during admission

Summary

Introduction

Sleep disordered breathing (SDB) is an upper airway dysfunction that results in the transient cessation of breathing during sleep and is diagnosed with polysomnography (PSG). Prevalence of SDB increases with age, while other important risk factors include obesity and male sex [1]. Prevalence of SDB is even higher among acute stroke patients, with nearly threefourths of patients having comorbid SDB [2]. Underscoring the importance of recognizing SDB in acute stroke and the potential for continuous positive airway pressure (CPAP) treatment to improve stroke outcomes, American Heart Association/American Stroke Association guidelines recommend considering sleep studies in patients with acute stroke and transient ischemic attack (TIA) [5,6]. Screening is rare after stroke, and outpatient polysomnography (PSG) testing may take weeks or months to perform [7,8]

Methods

Results

Conclusion