Sleep-disordered breathing is common in stroke patients. These patients don’t recover as quickly and are more likely to die or have a recurrent stroke, especially among nonwhite racial and ethnic populations. The American Heart Association/American Stroke Association guidelines recommend considering sleep studies in patients with acute stroke and transient ischemic attack. However, screening is rare after stroke and outpatient sleep study testing (polysomnography) may take weeks or months to perform.
Now Boston University School of Medicine (BUSM) researchers have developed a simple, fast hospital-based screening and testing method that correctly identified most patients with sleep apnea in a study.
“Our study underscores how common sleep apnea is among stroke patients, as approximately 80% of our patients had at least mild and almost 50% had moderate or severe sleep apnea. We showed that screening our patients and using a portable sleep testing device during admission resulted in an early diagnosis for this treatable disorder,” says corresponding author Hugo J. Aparicio, MD, MPH, assistant professor of neurology at BUSM and an investigator at the Framingham Heart Study, in a release.
The researchers screened for sleep apnea during a quality improvement study conducted at Boston Medical Center (BMC). They compared the use of three questionnaires (STOP-BANG, Berlin Questionnaire, and the Epworth Sleepiness Scale) that screen for sleep-disordered breathing to a diagnosis made using a portable sleep study testing device that patients wore overnight in the hospital.
They observed that one questionnaire, STOP-BANG, was easy to administer, brief, and had good sensitivity for screening stroke patients for this disorder. “In addition, the portable sleep testing device results were highly consistent with the gold standard testing with outpatient polysomnography, and we were able to diagnose the disorder early after the stroke, where interventions were most likely to occur, such as referral to a sleep medicine specialist,” says Aparicio, a neurologist at BMC.
According to the researchers, if medical providers can diagnose sleep apnea during admission for stroke, patients can then subsequently be referred to a sleep medicine specialist and be treated through interventions.
The researchers believe it is important for everyone, not just stroke patients, to know about the common signs and symptoms of sleep apnea including loud snoring, often feeling tired or fatigued during the day, witnessed apneas (when someone stops breathing during sleep), difficult to treat high blood pressure, and morning headaches. “While the disorder occurs more commonly among overweight and obese individuals and among persons with a history of stroke or heart attack, it is under-recognized and underdiagnosed in the general population as well.”
These findings appear online in the Journal of Clinical Medicine.
Funding for this study was provided by Boston University’s Spivack Neurosciences Program and Aram V. Chobanian Assistant Professorship and from the National Institute of Neurological Disorders and Stroke (L30 NS093634).