Mark I Boulos1, Anthony Wan2, James Im2, Sara Elias2, Fadi Frankul2, Mina Atalla2, Sandra E Black3, Vincenzo S Basile4, Arun Sundaram5, Julia J Hopyan5, Karl Boyle5, David J Gladstone5, Brian J Murray6, Richard H Swartz3. 1. Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada. Electronic address: mark.boulos@sunnybrook.ca. 2. Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada. 3. Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, School of Graduate Studies, University of Toronto, Toronto, ON, Canada. 4. Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada. 5. Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada. 6. Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada.
Abstract
OBJECTIVE: Despite its high prevalence and unfavorable clinical consequences, obstructive sleep apnea (OSA) often remains underappreciated after cerebrovascular events. The purpose of our study was to evaluate the clinical utility of four simple paper-based screening tools for excluding OSA after stroke or transient ischemic attack (TIA). PATIENTS/ METHODS: Sixty-nine inpatients and outpatients with stroke or TIA during the past 180 days completed the 4-Variable screening tool (4V), STOP-BAG questionnaire (ie, STOP-BANG questionnaire without the neck circumference measurement), Berlin questionnaire, and the Sleep Obstructive apnea score optimized for Stroke (SOS). They subsequently underwent objective testing using a portable sleep monitoring device. Cutoffs were selected to maximize sensitivity and exclude OSA (AHI ≥ 10) in ≥10% of the cohort. RESULTS: The mean age was 68.3 ± 14.2 years and 47.8% were male. Thirty-two patients (46.4%) were found to have OSA. Male sex, body mass index (BMI), and atrial fibrillation were independent predictors of OSA. Among the screening tools, the 4V had the greatest area under the curve (AUC) of 0.688 (p = 0.007); the sensitivity was 96.9% for a cutoff of <6. The STOP-BAG also significantly detected OSA with an AUC of 0.677 (p = 0.012); the sensitivity was 93.8% for a cutoff of <2. Scores on the 4V and STOP-BAG were significantly correlated with the AHI. CONCLUSIONS: The 4V and STOP-BAG questionnaire may aid clinicians with ruling out OSA within 180 days of stroke/TIA. Due to the atypical presentation of poststroke/TIA OSA, these tools are only moderately predictive; objective testing should still be used for OSA diagnosis in this population.
OBJECTIVE: Despite its high prevalence and unfavorable clinical consequences, obstructive sleep apnea (OSA) often remains underappreciated after cerebrovascular events. The purpose of our study was to evaluate the clinical utility of four simple paper-based screening tools for excluding OSA after stroke or transient ischemic attack (TIA). PATIENTS/ METHODS: Sixty-nine inpatients and outpatients with stroke or TIA during the past 180 days completed the 4-Variable screening tool (4V), STOP-BAG questionnaire (ie, STOP-BANG questionnaire without the neck circumference measurement), Berlin questionnaire, and the Sleep Obstructive apnea score optimized for Stroke (SOS). They subsequently underwent objective testing using a portable sleep monitoring device. Cutoffs were selected to maximize sensitivity and exclude OSA (AHI ≥ 10) in ≥10% of the cohort. RESULTS: The mean age was 68.3 ± 14.2 years and 47.8% were male. Thirty-two patients (46.4%) were found to have OSA. Male sex, body mass index (BMI), and atrial fibrillation were independent predictors of OSA. Among the screening tools, the 4V had the greatest area under the curve (AUC) of 0.688 (p = 0.007); the sensitivity was 96.9% for a cutoff of <6. The STOP-BAG also significantly detected OSA with an AUC of 0.677 (p = 0.012); the sensitivity was 93.8% for a cutoff of <2. Scores on the 4V and STOP-BAG were significantly correlated with the AHI. CONCLUSIONS: The 4V and STOP-BAG questionnaire may aid clinicians with ruling out OSA within 180 days of stroke/TIA. Due to the atypical presentation of poststroke/TIA OSA, these tools are only moderately predictive; objective testing should still be used for OSA diagnosis in this population.
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