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Related Concept Videos

Sleep Apnea01:21

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Sleep apnea is a condition where breathing stops intermittently during sleep, often leading to significant health issues. Each episode can last from 10 to 20 seconds or more and is frequently accompanied by a brief arousal from sleep. This disturbance, largely unnoticed by the individual, can lead to severe daytime fatigue. Commonly, individuals seek help after being informed by their partners about loud snoring and noticeable breathing pauses during sleep.
The condition is more prevalent among...
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Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
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Identifying obstructive sleep apnea after stroke/TIA: evaluating four simple screening tools.

Mark I Boulos1, Anthony Wan2, James Im2

  • 1Hurvitz 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.

Sleep Medicine
|July 25, 2016
PubMed
Summary

Simple screening tools like the 4-Variable (4V) and STOP-BAG can help rule out obstructive sleep apnea (OSA) in stroke patients. However, objective testing remains crucial for definitive OSA diagnosis post-stroke or TIA.

Keywords:
4-Variable screening toolBerlin questionnaireObstructive sleep apneaSTOP-BANG questionnaireSleep Obstructive apnea score optimized for StrokeStrokeTransient ischemic attack

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Cardiology

Background:

  • Obstructive sleep apnea (OSA) is common and impactful after cerebrovascular events but often overlooked.
  • Early identification of OSA post-stroke or transient ischemic attack (TIA) is critical for patient outcomes.

Purpose of the Study:

  • To assess the clinical usefulness of four simple, paper-based screening tools for excluding OSA in patients with recent stroke or TIA.
  • To determine the predictive accuracy of these screening tools compared to objective sleep monitoring.

Main Methods:

  • Sixty-nine stroke/TIA patients completed the 4-Variable (4V) tool, STOP-BAG, Berlin questionnaire, and Sleep Obstructive apnea score optimized for Stroke (SOS).
  • Objective sleep monitoring was performed to diagnose OSA (Apnea-Hypopnea Index ≥10).
  • Screening tool cutoffs were optimized for high sensitivity to exclude OSA in at least 10% of patients.

Main Results:

  • 46.4% of patients had OSA. Male sex, higher BMI, and atrial fibrillation predicted OSA.
  • The 4V tool demonstrated the highest Area Under the Curve (AUC) of 0.688, with 96.9% sensitivity for OSA exclusion at a cutoff of <6.
  • The STOP-BAG also showed significant OSA detection (AUC 0.677) with 93.8% sensitivity for exclusion at a cutoff of <2. Both correlated with Apnea-Hypopnea Index.

Conclusions:

  • The 4V and STOP-BAG questionnaires show potential in aiding clinicians to rule out OSA within 180 days post-stroke/TIA.
  • Due to atypical presentations, these tools offer moderate prediction, and objective sleep studies are still recommended for definitive OSA diagnosis in this population.