Obstructive Sleep Apnea, Stroke, Transient Ischemic Attack
Conditions
Keywords
Stroke, Transient ischemic attack, Obstructive sleep apnea, Portable sleep monitor, Screening
Brief summary
Obstructive sleep apnea (OSA) is common after stroke/TIA and, left untreated, is associated with recurrent vascular events, poor functional outcomes, and long-term mortality. Despite its high prevalence, OSA often remains underdiagnosed after stroke. The purpose of this study is to evaluate portable sleep monitors (PSMs) as a broad screening tool for OSA after stroke/TIA. The study investigators hypothesize that the screening with PSMs will lead to an increase in the diagnosis of treatable OSA after stroke/TIA and an improvement in sleep-related and functional outcomes.
Detailed description
Obstructive sleep apnea (OSA) is common after stroke and, left untreated, is associated with recurrent vascular events, poor functional outcomes, and long-term mortality. Despite its high prevalence, OSA often remains underdiagnosed after stroke. While in-laboratory polysomnography studies are the gold standard for diagnosing OSA, their use is limited by the lack of availability, patient unwillingness to sleep overnight at a laboratory and high costs. Home-based PSMs can accurately diagnose OSA and are much more accessible, convenient and low-priced compared to in-laboratory sleep studies. The primary purpose of this study is to determine whether broad screening for OSA using PSMs, as compared to usual care, increases the proportion of patients diagnosed with treatable OSA after stroke or TIA. Secondary aims include whether screening with PSMs increases the proportion of patients treated for OSA with continuous positive airway pressure (CPAP) and whether functional outcomes and sleep-related outcomes are improved. Finally, the study will also determine whether this approach is cost-effective.
Interventions
DEVICEPortable sleep monitor (ApneaLink Air)
Use of a portable sleep monitor that records respiratory effort, pulse, oxygen saturation and nasal flow, and reports apneas, hypopneas, flow limitation, snoring and blood oxygen saturation in order to detect obstructive sleep apnea.
Level 1 in-laboratory polysomnography for the detection of obstructive sleep apnea.
Sponsors
Unity Health Toronto
Sunnybrook Health Sciences Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Imaging-confirmed stroke or stroke-neurologist diagnosed TIA in the past 6-months, and * Outpatients being managed at the Sunnybrook Stroke Prevention clinic or inpatients on the Sunnybrook Stroke Unit.
Exclusion criteria
* Prior diagnosis of OSA * Current use of CPAP * Life expectancy less than 12 months * The presence of conditions known to compromise the accuracy of portable sleep monitoring, such as moderate to severe pulmonary disease or congestive heart failure * Oxygen therapy (eg. nasal prongs), a nasogastric tube, or other medical devices that would interfere with the placement of the sensors of the sleep monitoring device and/or CPAP * Physical impairment, aphasia, or language barrier restricting ability to complete study assessments, overnight sleep monitoring, and/or comply with CPAP therapy, and no caregiver available to assist the patient with the study requirements * Facial or bulbar weakness or trauma restricting the ability to create a seal with a CPAP mask * Pregnancy * Occupation that would make randomization to the standard of care arm unethical * Not covered by Ontario health insurance plan (OHIP) * Unable to attend follow-up assessments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients diagnosed with treatable OSA | 6 & 12 months | Proportion of patients diagnosed with treatable OSA by 6 & 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cost to deliver each management strategy and treatment | 6 months | Cost to deliver each management strategy and treatment by 6 months |
| Sleep-related quality of life (Functional Outcomes of Sleep Quality questionnaire) | 6 months | Sleep-related quality of life (Functional Outcomes of Sleep Quality questionnaire) at 6 months |
| Daytime sleepiness (Epworth Sleepiness Scale) | 6 & 12 months | Daytime sleepiness (Epworth Sleepiness Scale) at 6 & 12 months |
| Neurological outcomes (as assessed by the Stroke Impact Scale) | 6 months | Neurological outcomes (as assessed by the Stroke Impact Scale) at 6 months |
| Proportion of patients prescribed CPAP for treatable OSA | 6 & 12 months | Proportion of patients prescribed CPAP for treatable OSA by 6 & 12 months |
| Neurological outcomes (as assessed by the National Institutes of Health stroke scale) | 6 months | Neurological outcomes (as assessed by the National Institutes of Health stroke scale) at 6 months |
| 24-hr ambulatory blood pressure | 6 months | 24-hr ambulatory blood pressure at 6 months |
| New vascular events (stroke, TIA, myocardial infarction, coronary artery stenting) | 12 months | Assessed via telephone call at 12 months |
| Neurological outcomes (as assessed by the modified Rankin scale) | 6 months | Neurological outcomes (as assessed by the modified Rankin scale) at 6 months |
Countries
Canada
Outcome results
None listed