King Sharon, Cuellar Norma
Questions or comments about this article may be directed to Sharon King, DNP NP-C, at
J Neurosci Nurs. 2016 Jun;48(3):133-42. doi: 10.1097/JNN.0000000000000196.
Stroke is a leading cause of death and disability affecting nearly 800,000 people in the United States every year. Obstructive sleep apnea (OSA) is found in over 60% of patients with stroke/transient ischemic attack (TIA) and identified as an independent stroke risk factor in large epidemiology studies and Canadian Stroke Prevention Guidelines (SPG) but not in the United States. The 2014 Secondary SPG recommend OSA screening and treatment as a consideration only, not a requirement. The twofold purpose of this article is, first, to present the evidence supporting OSA as an independent stroke risk factor in national SPG with mandatory recommendations and, second, to engage neuroscience nurses to incorporate OSA assessment and interventions into the nursing process and thereby promote excellence in stroke/TIA patient care.
A systematic literature search was conducted in Medline, CINAHL, and PubMed to identify research from 2003 through 2013 on the independent risk, mortality, and prevalence relationship between OSA and stroke/TIA including recurrence and recovery outcomes with continuous positive airway pressure (CPAP) therapy.
Twenty-eight research articles were reviewed: 14 observational cohorts, five case-control studies, four cross-sectional studies, and four randomized control trials representing 12 countries and 10,671 subjects.
OSA is highly prevalent in patients with stroke/TIA independently increasing stroke risk. CPAP studies revealed reduced stroke recurrence and improved recovery with feasible initiation in stroke units. Patients with stroke/TIA have less OSA-associated daytime sleepiness and obesity, making the usual screening tools insufficient and CPAP adherence challenging. Treating OSA decreases stroke prevalence and mortality. OSA initiatives empower neuroscience nurses to integrate this OSA evidence into clinical practice and improve stroke/TIA patient outcomes.
中风是导致死亡和残疾的主要原因，在美国每年影响近80万人。超过60%的中风/短暂性脑缺血发作（TIA）患者存在阻塞性睡眠呼吸暂停（OSA），在大型流行病学研究和加拿大中风预防指南（SPG）中，OSA被确定为独立的中风风险因素，但在美国并非如此。2014年的二级SPG仅建议考虑对OSA进行筛查和治疗，而非强制要求。本文的双重目的是，首先，在具有强制性建议的国家SPG中展示支持OSA作为独立中风风险因素的证据；其次，促使神经科学护士将OSA评估和干预纳入护理过程，从而提升中风/TIA患者的护理质量。
在Medline、CINAHL和PubMed中进行系统的文献检索，以识别2003年至2013年期间关于OSA与中风/TIA之间的独立风险、死亡率和患病率关系的研究，包括持续气道正压通气（CPAP）治疗的复发和恢复结果。
共审查了28篇研究文章：14项观察性队列研究、5项病例对照研究、4项横断面研究和4项随机对照试验，涉及12个国家的10671名受试者。
OSA在中风/TIA患者中高度普遍，独立增加中风风险。CPAP研究表明，在中风单元中可行的起始治疗可降低中风复发率并改善恢复情况。中风/TIA患者与OSA相关的日间嗜睡和肥胖情况较少，使得常用的筛查工具不足，且CPAP依从性具有挑战性。治疗OSA可降低中风患病率和死亡率。OSA相关举措使神经科学护士能够将这一OSA证据整合到临床实践中，并改善中风/TIA患者的预后。
