Polysomnography Utilization in Veterans Presenting Acutely with Ischemic Stroke or Transient Ischemic Attack

Area of Science:

• Neurology
• Sleep Medicine
• Public Health

Background:

• Obstructive sleep apnea (OSA) is a significant independent risk factor for cerebrovascular events, including ischemic stroke and transient ischemic attack (TIA).
• Clinical evidence indicates that prompt diagnosis and treatment of OSA can improve functional outcomes in patients who have experienced acute ischemic stroke.
• The prevalence of OSA is notably high among individuals with a history of stroke or TIA.

Purpose of the Study:

• To evaluate the utilization rates of polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA).
• To assess PSG utilization trends over a two-year period in US Veterans diagnosed with acute stroke or TIA.
• To identify factors associated with PSG testing in this patient population.

Main Methods:

• The study included US Veterans diagnosed with acute ischemic stroke or TIA between October 2015 and June 2017.
• Data on demographic characteristics, clinical information, and PSG testing within 12 months post-discharge were extracted from the VA Corporate Data Warehouse.
• Statistical analyses, including Fisher's exact test, two-sample t tests, and mixed-effect logistic regression, were employed to determine PSG utilization rates and associated factors.

Main Results:

• Overall PSG utilization remained low and stable, with only 6.0% in FY 2016 and 6.2% in FY 2017 of eligible Veterans undergoing the test.
• Younger Veterans (<60 years) had significantly higher odds of receiving PSG compared to older Veterans (≥80 years).
• Comorbidities such as diabetes and heart failure were associated with increased PSG likelihood, while dementia was linked to decreased likelihood.

Conclusions:

• Polysomnography (PSG) utilization for obstructive sleep apnea (OSA) diagnosis in US Veterans following stroke or TIA is critically low and has not improved.
• Vulnerable populations, including older Veterans and those with dementia, are less likely to undergo recommended PSG testing.
• There is a need to enhance OSA screening and diagnostic procedures in Veterans post-stroke or TIA to improve long-term health outcomes.