Modified Berlin Score for predicting sleep apnea in patients with acute ischemic stroke

Area of Science:

• Neurology
• Sleep Medicine
• Cardiovascular Research

Background:

• Sleep-disordered breathing is prevalent in ischemic stroke patients, increasing stroke risk and worsening functional outcomes.
• Polysomnography (PSG) is the gold standard for diagnosis but impractical for acute stroke patients.
• The Berlin Questionnaire (BQ) is a screening tool with inconsistent accuracy in acute ischemic stroke.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the BQ for sleep apnea in acute ischemic stroke patients.
• To compare the accuracy of the BQ with a modified BQ (mBQ) using home-based sleep apnea testing as a reference.

Main Methods:

• Prospective observational study in Taiwan (March 2023 - February 2025).
• Included 46 patients (20-85 years) with MRI-confirmed acute ischemic stroke within 48 hours of onset.
• Assessed sleep apnea using the BQ, modified BQ, and home-based sleep apnea testing (Alice NightOne), defining severity by Respiratory Event Index (REI ≥ 15 for moderate-to-severe).

Main Results:

• 54.3% of patients had moderate-to-severe sleep apnea (REI ≥ 15).
• Alcohol use and higher BMI were significantly associated with moderate-to-severe apnea (p=0.01).
• The BQ showed moderate accuracy (sensitivity 45.8%, specificity 72.7%), while mBQ improved sensitivity (54.1%) with similar specificity (72.7%). Moderate-to-severe apnea correlated with lower minimum oxygen saturation (p=0.03).

Conclusions:

• The BQ offers moderate accuracy for sleep apnea screening in acute ischemic stroke, with improved performance when BMI weighting is modified.
• Moderate-to-severe sleep apnea is linked to reduced oxygen saturation, underscoring the need for early screening in stroke units.
• Further multicenter studies are recommended to validate findings and investigate the prognostic impact of nocturnal hypoxemia on stroke recovery.