Abstract Details

Title Screening for Obstructive Sleep Apnea in Stroke and TIA Patients using a Home Sleep Apnea Test vs. In-laboratory Polysomnography: A Randomized Controlled Trial

Topic Sleep

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-003

Objective To determine whether screening for obstructive sleep apnea (OSA) using a home sleep apnea test (HSAT), compared to usual care with in-laboratory polysomnography (PSG), significantly increases the proportion of stroke/TIA patients (i) diagnosed with OSA and (ii) managed with continuous positive airway pressure (CPAP), as well as improves (iii) daytime sleepiness and (iv) functional outcomes at 6 months. We also assessed whether HSAT, compared to PSG, was a cost-effective method for diagnosing OSA.

Background OSA occurs in most patients with stroke/TIA and is linked with numerous unfavourable health consequences. Despite being readily treatable, OSA remains underdiagnosed in this clinical setting. One reason is because in-laboratory PSG, the current standard tool for assessing OSA, is limited by low availability and patient inconvenience. Fortunately, HSAT can also accurately diagnose OSA, and is much more convenient compared to in-laboratory PSG.

Design/Methods We consecutively recruited 250 patients who had sustained a stroke/TIA within the past 6 months. Patients were randomized (1:1) to use of (i) HSAT vs. (ii) in-laboratory PSG. Outcomes were assessed at 6 months.

Results At 6 months, a significantly greater proportion of patients in the HSAT arm had been diagnosed with OSA and prescribed CPAP. Patients in the HSAT arm also reported significantly reduced daytime sleepiness and a greater ability to perform daily activities. Moreover, a cost-effectiveness analysis revealed that HSAT was less costly and more effective for the detection of OSA compared to usual care using in-laboratory PSG.

Conclusions In stroke/TIA patients, use of HSAT compared to PSG increases rates of OSA diagnosis and treatment, reduces daytime sleepiness, improves functional outcomes, and could be an economically attractive approach. This novel ambulatory approach to OSA detection may also improve outcomes and reduce expenditures in other clinical populations. Moreover, our results suggest that future funding arrangements should be aligned to encourage more home-based sleep investigations.

Authors/Disclosures
Mark I. Boulos, MD, FRCPC, CSCN(EEG), MSc (Sunnybrook Health Sciences Centre) PRESENTER	Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Precision AQ. Dr. Boulos has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Takeda. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Techspert. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Sleep Medicine (journal). The institution of Dr. Boulos has received research support from Canadian Institutes of Health Research. The institution of Dr. Boulos has received research support from RLS Foundation. The institution of Dr. Boulos has received research support from Temerty Centre for AI Research and ��ɫ�� in Medicine (T-CAIREM). The institution of Dr. Boulos has received research support from Heart & Stroke Foundation of Canada. The institution of Dr. Boulos has received research support from Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. The institution of Dr. Boulos has received research support from StrokeCog. The institution of Dr. Boulos has received research support from McLaughlin Centre for Molecular Medicine . The institution of Dr. Boulos has received research support from Zoll Itamar. The institution of Dr. Boulos has received research support from Toronto Dementia Research Alliance. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Jazz Pharmaceuticals. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Lundbeck.
	No disclosure on file
David R. Colelli, MSc (Sunnybrook Health Science Centre)	Mr. Colelli has nothing to disclose.
	No disclosure on file
David J. Gladstone, MD	No disclosure on file
Karl O. Boyle, MD (Department of Stroke Medicine)	No disclosure on file
	No disclosure on file
Julia J. Hopyan, MD	No disclosure on file
Richard H. Swartz, BSc MD PhD FRCPC (Sunnybrook Health Sciences Centre)	The institution of Dr. Swartz has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Swartz has received research support from Ontario Brain Institute.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Brian J. Murray, MD, FAAN	The institution of Dr. Murray has received research support from Wake Up Narcolepsy. Dr. Murray has received publishing royalties from a publication relating to health care.

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