Patient Insights on Integrating Sleep Apnea Testing into Routine Stroke and TIA Care

AHA/ASA guidelines recommend patients with ischemic stroke or transient ischemic attack (TIA) be considered for obstructive sleep apnea (OSA) evaluation, given the high prevalence of OSA and improved outcomes for cerebrovascular disease when OSA is treated. However, OSA testing has not been incorporated into routine cerebrovascular management. We interviewed 30 patients hospitalized for acute stroke/TIA at six Veterans Affairs facilities participating in a stepped-wedge implementation trial to improve timely OSA testing after stroke/TIA. Thematic analysis of semi-structured interviews explored the experiences of care received, sleep testing, and education about the association between OSA and cerebrovascular disease. Patients perceived OSA testing as an integrated component of stroke/TIA care and reported few barriers to OSA testing. Patients had limited recall of details concerning sleep testing during hospitalization and education about OSA but expressed preferences about the timing, setting, and importance of caregiver participation. Patients expressed high levels of acceptance of sleep testing as a routine part of cerebrovascular care. Facilities could use these results to implement guideline-concordant screening for OSA, post-stroke/TIA.