Identifying obstructive sleep apnea after stroke/TIA: evaluating four simple screening tools

Boulos, Mark I.; A, Wan; Im, James; Elias, Sara; Frankul, Fadi; Atalla, Mina; Black, Sandra E.; Basile, Vincenzo S.; Sundaram, Arun; Hopyan, Julia; Boyle, Karl; Gladstone, David J.; Murray, Brian J.; Swartz, Richard H.

doi:10.1016/j.sleep.2015.12.013

Cited by 35 publications

(58 citation statements)

References 40 publications

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“…7 Boulos et al similarly reported that the BQ did not predict the presence of OSA among patients with stroke (mixed ischemic and hemorrhagic) or TIA. 10 Our current study confirms the lower sensitivity, specificity, and predictive values in a study population exclusively with ischemic stroke or TIA, rather than a mixed ischemic and hemorrhagic stroke population.…”

Section: Discussionsupporting

confidence: 77%

“…5 Several well-validated sleep instruments used in the general population to screen for OSA and perceived somnolence, such as the Berlin Questionnaire (BQ) 8 and Epworth Sleepiness Scale (ESS) score, 6 rely heavily on symptomatic features of OSA, but have not been predictive of OSA (as defined by an Apnea-Hypopnea Index [AHI] ≥5 on polysomnography [PSG]) in mixed stroke populations (ischemic and hemorrhagic). 5,7 A modified version of the Snoring, Tiredness, Observed Apnea, high blood Pressure-Body mass index, Age, Neck circumference, and Gender (STOP-BANG) was only moderately predictive of OSA compared with home sleep testing equipment among patients with a cerebrovascular event, 9,10 whereas the Sleep Apnea Clinical Score (SACS) has not been studied among patients with cerebrovascular disease. Given the suboptimal performance of commonly used OSA screening instruments within the stroke or TIA population, authors have suggested that the development of models based on medical comorbidity should be pursued.…”

Section: Introductionmentioning

confidence: 99%

“…Given the suboptimal performance of commonly used OSA screening instruments within the stroke or TIA population, authors have suggested that the development of models based on medical comorbidity should be pursued. 10 …”

Section: Introductionmentioning

confidence: 99%

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Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea

Sico

Yaggi

Ofner

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background Screening instruments for obstructive sleep apnea (OSA), as used routinely to guide clinicians regarding patient referral for polysomnography (PSG), rely heavily on symptomatology. We sought to develop and validate a cerebrovascular disease-specific OSA prediction model less reliant on symptomatology, and to compare its performance with commonly used screening instruments within a population with ischemic stroke or transient ischemic attack (TIA). Methods Using data on demographic factors, anthropometric measurements, medical history, stroke severity, sleep questionnaires, and PSG from 2 independently derived, multisite, randomized trials that enrolled patients with stroke or TIA, we developed and validated a model to predict the presence of OSA (i.e., Apnea-Hypopnea Index ≥5 events per hour). Model performance was compared with that of the Berlin Questionnaire, Epworth Sleepiness Scale (ESS), the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender instrument, and the Sleep Apnea Clinical Score. Results The new SLEEP Inventory (Sex, Left heart failure, ESS, Enlarged neck, weight [in Pounds], Insulin resistance/ diabetes, and National Institutes of Health Stroke Scale) performed modestly better than other instruments in identifying patients with OSA, showing reasonable discrimination in the development (c-statistic .732) and validation (c-statistic .731) study populations, and having the highest negative predictive value of all in struments. Conclusions Clinicians should be aware of these limitations in OSA screening instruments when making decisions about referral for PSG. The high negative predictive value of the SLEEP INventory may be useful in determining and prioritizing patients with stroke or TIA least in need of overnight PSG.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea

Sico

Yaggi

Ofner

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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“…The prevalence of sleep apnea in the present study is comparable to that among Mexican American and non-Hispanic white stroke survivors who were assessed using the Berlin questionnaire [11]. However, amongst Korean (n=293) and Brazilian (n=69) acute stroke survivors, the frequencies of sleep-disordered breathing determined by polysomnography within 1 week post-stroke were 63.1% and 76.8% respectively [23, 24] compared with a rate of 46% among Canadian stroke survivors assessed within 6 months after stroke [25]. It is unknown whether these differences observed in sleep apnea prevalence are due to the divergent methods used for assessing sleep apnea, the populations studied, or the time points after stroke at which sleep apnea was assessed.…”

Section: Discussionmentioning

confidence: 86%

Prevalence and Predictors of Sleep Apnea Risk among Ghanaian Stroke Survivors

Jenkins

Mensah

Saulson

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background & Purpose Sleep apnea has emerged as a potent risk factor for stroke recurrence and mortality. The burden of sleep apnea among stroke survivors in sub-Saharan Africa where stroke incidence and mortality are escalating is unknown. We sought to assess the prevalence of sleep apnea risk and its clinical correlates and predictors among Ghanaian stroke survivors. Methods This cross-sectional study involved 200 consecutive stroke survivors attending a Neurology clinic in a tertiary medical center in Kumasi, Ghana. The validated Berlin, STOP-BANG and Epworth Sleepiness Scale questionnaires were administered to all eligible subjects to assess sleep apnea risk and daytime somnolence after collecting demographic, clinical, health-related quality of life, and symptoms of depression using questionnaires. Results Median (IQR) age of stroke survivors was 62 (52–72) years and 52.5% were males. 99 (49.5%) subjects were identified as high risk for sleep apnea using the Berlin questionnaire while the STOP-BANG questionnaire classified 26 (13%), 137 (68.5%) and 37 (18.5%) subjects as low, intermediate and high risk for SA respectively. Patients at high risk of sleep apnea were significantly older, used excess alcohol and were less able to perform activities of daily living, although their mean NIHSS scores were significantly lower than those with low risk for sleep apnea. None of the stroke survivors had ever been screened for SA. Conclusions One out of every two stroke survivors attending a Neurology clinic in Ghana is at high risk for undiagnosed sleep apnea. Greater regional awareness about sleep apnea presence and outcomes among patients and providers is warranted.

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“…Alternatively, obstructive apneas in these diseases may have different characteristics than in the general or in sleep laboratory populations, and generate more soft snoring that may make them less evident to bed partners. The most common OSA screening questionnaires proved poorly performant in CKD (31), and other screening tools have been advocated, as it was the case in other diseases, like stroke or diabetes (32,33). Developing new tools could have clinically important consequences, since the clinical course of CKD might improve if OSA is recognised and treated.…”

Section: Editorialmentioning

confidence: 99%

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

Marrone

Bonsignore

2018

J. Thorac. Dis.

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Identifying obstructive sleep apnea after stroke/TIA: evaluating four simple screening tools

Cited by 35 publications

References 40 publications

Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea

Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea

Prevalence and Predictors of Sleep Apnea Risk among Ghanaian Stroke Survivors

Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem

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