Department of Neurology, Sleep Disorders Center, Cleveland Clinic Neurological Institute, 9500 Euclid Avenue, S73, Cleveland, OH, 44195, USA.
Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
Sleep Breath. 2024 Dec;28(6):2539-2546. doi: 10.1007/s11325-024-03161-7. Epub 2024 Sep 16.
Untreated obstructive sleep apnea (OSA) in patients with acute ischemic stroke (AIS) is associated with increased morbidity and mortality. However, diagnosing and treating OSA in AIS is challenging. We aimed to determine the feasibility of portable monitoring (PM) for diagnosis and positive airway pressure therapy for treatment of OSA in an inpatient stroke population.
We recruited inpatients with AIS from Cleveland Clinic. Those who consented underwent PM; participants with a respiratory event index (REI) ≥ 10 were offered auto-titrating positive airway pressure therapy (APAP). Ease-of-use questionnaires were completed. We summarized categorical variables using n(%) and continuous variables using mean ± SD or median [IQR].
27 participants (age 59.8 ± 11.8, 51.9% female, 51.9% Black, BMI 33.4 ± 8.5) enrolled. The study ended early due to Medicare contracting that forced most patients to complete stroke rehabilitation outside the Cleveland Clinic health system. 59.3% had large vessel occlusions and 53.8% had moderate/severe disability (Modified Rankin score ≥ 2). PM was attempted in 21 participants, successful in 18. Nurses and patients rated the PM device as highly easy to use. 13 of 18 (72%) patients who had an REI ≥ 10 consented to APAP titration, but only eight (61.5%) of those 13 used APAP for more than one night, and only five (27.8%) used APAP up to 90 days with data captured for only one participant. Five required troubleshooting at titration, and only one had adherent APAP usage by objective assessment after discharge.
This study demonstrates the real-world challenges of assessing and treating OSA in an AIS population, highlighting the necessity for further research into timely and feasible screening and treatment.
未经治疗的阻塞性睡眠呼吸暂停（OSA）与急性缺血性脑卒中（AIS）患者的发病率和死亡率增加有关。然而，在 AIS 患者中诊断和治疗 OSA 具有挑战性。我们旨在确定便携式监测（PM）在诊断 AIS 住院患者 OSA 中的可行性，以及正压通气治疗（APAP）在治疗 OSA 中的可行性。
我们从克利夫兰诊所招募了 AIS 住院患者。同意参加的患者接受 PM；呼吸事件指数（REI）≥10 的患者被提供自动滴定正压通气治疗（APAP）。完成易用性问卷。我们使用 n(%)和平均值±标准差或中位数[IQR]来总结分类变量。
27 名参与者（年龄 59.8±11.8，51.9%为女性，51.9%为黑人，BMI 33.4±8.5）入组。由于医疗保险合同的原因，大多数患者必须在克利夫兰诊所医疗系统之外完成中风康复，导致研究提前结束。59.3%的患者有大血管闭塞，53.8%的患者有中度/重度残疾（改良Rankin 评分≥2）。21 名参与者尝试了 PM，18 名成功。护士和患者认为 PM 设备非常易于使用。18 名患者中有 13 名（72%）REI≥10 同意进行 APAP 滴定，但只有 8 名（61.5%）中的 13 名患者使用 APAP 超过一晚，只有 5 名（27.8%）使用 APAP 长达 90 天，只有一名参与者的数据被捕获。5 名患者在滴定过程中需要故障排除，只有 1 名患者在出院后通过客观评估具有 APAP 治疗的依从性。
本研究展示了在 AIS 人群中评估和治疗 OSA 的实际挑战，强调了进一步研究及时可行的筛查和治疗的必要性。
