Screening for Obstructive Sleep Apnea in Stroke and TIA Patients using a Home Sleep Apnea Test vs. In-laboratory Polysomnography: A Randomized Controlled Trial
Mark Boulos1, Maneesha Kamra1, David Colelli1, Nardin Kirollos1, David Gladstone1, Karl Boyle1, Arun Sundaram1, Julia Hopyan1, Richard Swartz1, Muhammad Mamdani2, Wanrudee Isaranuwatchai 2, Kevin Thorpe3, Brian Murray1
1Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, 2Li Ka Shing Knowledge Institute, St. Michael's Hospital, 3Applied Health Research Centre & Dalla Lana School of Public Health, University of Toronto
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.