SLEAP SMART (Sleep Apnea Screening Using Mobile Ambulatory Recorders After TIA/Stroke): A Randomized Controlled Trial.

Aged Aged, 80 and over Female Humans Ischemic Attack, Transient / diagnosis Male Middle Aged Polysomnography Sleep Apnea, Obstructive / complications Stroke / diagnosis
ambulatory care clinical trial ischemic attack, transient laboratories polysomnography sleep apnea, obstructive stroke

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
03 2022
Historique:
pubmed: 12 10 2021
medline: 11 3 2022
entrez: 11 10 2021
Statut: ppublish

Résumé

Poststroke/transient ischemic attack obstructive sleep apnea (OSA) is prevalent, linked with numerous unfavorable health consequences, but remains underdiagnosed. Reasons include patient inconvenience and costs associated with use of in-laboratory polysomnography (iPSG), the current standard tool. Fortunately, home sleep apnea testing (HSAT) can accurately diagnose OSA and is potentially more convenient and cost-effective compared with iPSG. Our objective was to assess whether screening for OSA in patients with stroke/transient ischemic attack using HSAT, compared with standard of care using iPSG, increased diagnosis and treatment of OSA, improved clinical outcomes and patient experiences with sleep testing, and was a cost-effective approach. We consecutively recruited 250 patients who had sustained a stroke/transient ischemic attack within the past 6 months. Patients were randomized (1:1) to use of (1) HSAT versus (2) iPSG. Patients completed assessments and questionnaires at baseline and 6-month follow-up appointments. Patients diagnosed with OSA were offered continuous positive airway pressure. The primary outcome was compared between study arms via an intention-to-treat analysis. At 6 months, 94 patients completed HSAT and 71 patients completed iPSG. A significantly greater proportion of patients in the HSAT arm were diagnosed with OSA (48.8% versus 35.2%, In patients with stroke/transient ischemic attack, use of HSAT compared with iPSG increases the rate of OSA diagnosis and treatment, reduces daytime sleepiness, improves functional outcomes and experiences with sleep testing, and could be an economically attractive approach. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02454023.

Sections du résumé

BACKGROUND AND PURPOSE
Poststroke/transient ischemic attack obstructive sleep apnea (OSA) is prevalent, linked with numerous unfavorable health consequences, but remains underdiagnosed. Reasons include patient inconvenience and costs associated with use of in-laboratory polysomnography (iPSG), the current standard tool. Fortunately, home sleep apnea testing (HSAT) can accurately diagnose OSA and is potentially more convenient and cost-effective compared with iPSG. Our objective was to assess whether screening for OSA in patients with stroke/transient ischemic attack using HSAT, compared with standard of care using iPSG, increased diagnosis and treatment of OSA, improved clinical outcomes and patient experiences with sleep testing, and was a cost-effective approach.
METHODS
We consecutively recruited 250 patients who had sustained a stroke/transient ischemic attack within the past 6 months. Patients were randomized (1:1) to use of (1) HSAT versus (2) iPSG. Patients completed assessments and questionnaires at baseline and 6-month follow-up appointments. Patients diagnosed with OSA were offered continuous positive airway pressure. The primary outcome was compared between study arms via an intention-to-treat analysis.
RESULTS
At 6 months, 94 patients completed HSAT and 71 patients completed iPSG. A significantly greater proportion of patients in the HSAT arm were diagnosed with OSA (48.8% versus 35.2%,
CONCLUSIONS
In patients with stroke/transient ischemic attack, use of HSAT compared with iPSG increases the rate of OSA diagnosis and treatment, reduces daytime sleepiness, improves functional outcomes and experiences with sleep testing, and could be an economically attractive approach. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02454023.

Identifiants

DOI: 10.1161/STROKEAHA.120.033753 PMID: 34628939
pubmed: 34628939
doi: 10.1161/STROKEAHA.120.033753
doi:

Banques de données

ClinicalTrials.gov
['NCT02454023']

Types de publication

Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

710-718

Commentaires et corrections

Type : CommentIn

Auteurs

Mark I Boulos (MI)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).
ORCID: 0000-0002-9547-1889

Maneesha Kamra (M)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

David R Colelli (DR)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).
ORCID: 0000-0002-5585-6573

Nardin Kirolos (N)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

David J Gladstone (DJ)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

Karl Boyle (K)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

Arun Sundaram (A)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

Julia J Hopyan (JJ)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

Richard H Swartz (RH)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

Muhammad Mamdani (M)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

Desmond Loong (D)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).
ORCID: 0000-0001-8884-6550

Wanrudee Isaranuwatchai (W)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

Brian J Murray (BJ)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).
ORCID: 0000-0001-5085-0909

Kevin E Thorpe (KE)

Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., M.K., D.R.C., N.K., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.).
Department of Medicine, Division of Neurology (M.I.B., D.J.G., K.B., A.S., J.J.H., R.H.S., B.J.M.), University of Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation (D.L., W.I.), University of Toronto, Ontario, Canada.
Applied Health Research Centre & Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.I.B., B.J.M.).
Stroke Medicine, Beaumont Hospital, Dublin, Ireland (K.B.).
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada (M.M., D.L., W.I).

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › SLEAP SMART (Sleep Apnea Screening Using...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › SLEAP SMART (Sleep Apnea Screening Using...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › SLEAP SMART (Sleep Apnea Screening Using...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Accident ischémique transitoire › SLEAP SMART (Sleep Apnea Screening Using...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › SLEAP SMART (Sleep Apnea Screening Using...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Monitorage physiologique › Polysomnographie › SLEAP SMART (Sleep Apnea Screening Using...
questionsmedicales.fr › Maladies du système nerveux › Syndromes d'apnées du sommeil › Syndrome d'apnées obstructives du sommeil › SLEAP SMART (Sleep Apnea Screening Using...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › SLEAP SMART (Sleep Apnea Screening Using...