Performance of questionnaires to predict sleep-disordered breathing in acute stroke patients
Martijn Petrus Josephus Dekkers
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Contribution: Conceptualization, Investigation, Writing - original draft, Methodology, Visualization, Formal analysis, Data curation, Writing - review & editing
Search for more papers by this authorCorresponding Author
Christian Michael Horvath
Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Correspondence
Christian Michael Horvath, Universitätsklinik für Pneumologie, Allergologie und klinische Immunologie, Inselspital Bern, Universitätsspital Bern, Universität Bern, Freiburgstrasse 20, 3010 Bern, Switzerland.
Email: [email protected]
Contribution: Writing - original draft, Methodology, Writing - review & editing, Conceptualization
Search for more papers by this authorVanessa S. Woerz
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Contribution: Investigation, Writing - review & editing, Data curation
Search for more papers by this authorCorrado Bernasconi
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Writing - review & editing, Validation
Search for more papers by this authorSimone B. Duss
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Investigation, Writing - review & editing, Resources, Project administration
Search for more papers by this authorMarkus H. Schmidt
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Writing - review & editing, Validation, Supervision, Investigation
Search for more papers by this authorMauro Manconi
Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
Contribution: Resources, Supervision, Writing - review & editing, Investigation
Search for more papers by this authorAnne-Kathrin Brill
Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Writing - review & editing, Validation, Methodology
Search for more papers by this authorClaudio L. A. Bassetti
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia
Contribution: Resources, Supervision, Writing - review & editing, Funding acquisition, Investigation
Search for more papers by this authorMartijn Petrus Josephus Dekkers
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Contribution: Conceptualization, Investigation, Writing - original draft, Methodology, Visualization, Formal analysis, Data curation, Writing - review & editing
Search for more papers by this authorCorresponding Author
Christian Michael Horvath
Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Correspondence
Christian Michael Horvath, Universitätsklinik für Pneumologie, Allergologie und klinische Immunologie, Inselspital Bern, Universitätsspital Bern, Universität Bern, Freiburgstrasse 20, 3010 Bern, Switzerland.
Email: [email protected]
Contribution: Writing - original draft, Methodology, Writing - review & editing, Conceptualization
Search for more papers by this authorVanessa S. Woerz
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Contribution: Investigation, Writing - review & editing, Data curation
Search for more papers by this authorCorrado Bernasconi
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Writing - review & editing, Validation
Search for more papers by this authorSimone B. Duss
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Investigation, Writing - review & editing, Resources, Project administration
Search for more papers by this authorMarkus H. Schmidt
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Writing - review & editing, Validation, Supervision, Investigation
Search for more papers by this authorMauro Manconi
Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
Contribution: Resources, Supervision, Writing - review & editing, Investigation
Search for more papers by this authorAnne-Kathrin Brill
Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Contribution: Writing - review & editing, Validation, Methodology
Search for more papers by this authorClaudio L. A. Bassetti
Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Bern, Switzerland
Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia
Contribution: Resources, Supervision, Writing - review & editing, Funding acquisition, Investigation
Search for more papers by this authorMartijn Petrus Josephus Dekkers, Christian Michael Horvath, Anne-Kathrin Brill and Claudio L.A. Bassetti contributed equally to this study.
Summary
Sleep-disordered breathing is common in stroke and may negatively affect its outcome. Screening for sleep-disordered breathing in this setting is of interest but poorly studied. We aimed to evaluate the performance of eight obstructive sleep apnea screening questionnaires to predict sleep-disordered breathing in acute stroke or transient ischaemic attack patients, and to assess the impact of stroke/transient ischaemic attack-specific factors on sleep-disordered breathing prediction. We analysed acute stroke/transient ischaemic attack patients (N = 195) from a prospective cohort (“Sleep Deficiency and Stroke Outcome study”). Assessments included anthropometrics, stroke-specific parameters, sleep history, an in-hospital respiratory polygraphy within the first week after stroke, and obstructive sleep apnea screening questionnaires (Berlin Questionnaire, Epworth Sleepiness Scale, STOP-BANG, NoSAS, Sleep Apnea Clinical Score, No-Apnea, Sleep Obstructive apnea score optimized for Stroke, SLEEP-IN). In a binary classification task for respiratory event index ≥ 15 per hr, we evaluated the performance of the above-mentioned questionnaires. We used logistic regression to identify predictors for sleep-disordered breathing in this cohort. The areas under the curve for respiratory event index ≥ 15 per hr were: Berlin Questionnaire 0.60; STOP-BANG 0.72; NoSAS 0.69; No-Apnea 0.69; Sleep Apnea Clinical Score 0.75; Epworth Sleepiness Scale 0.50; Sleep Obstructive apnea score optimized for Stroke 0.58; and SLEEP-IN 0.67. The No-Apnea had the lowest false omission rate (0.13), a sensitivity of 0.97 and a specificity of 0.12. In multiple logistic regression analysis (respiratory event index ≥ 15 per hr), age, neck circumference, National Institutes of Health Stroke Scale at admission, prior stroke, cardioembolic stroke aetiology and observed apneas were associated with sleep-disordered breathing. The logistic regression model performed similar (area under the curve 0.80) to Sleep Apnea Clinical Score (p = 0.402) and STOP-BANG (p = 0.127), but outperformed the other questionnaires. Neither existing questionnaires nor our statistical model are sufficient to accurately diagnose sleep-disordered breathing after stroke, thus requiring sleep study evaluation. The No-Apnea questionnaire may help to identify patients amenable to sleep testing.
CONFLICT OF INTEREST STATEMENT
The authors report no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| jsr14416-sup-0001-Supinfo.docxWord 2007 document , 145.3 KB | DATA S1. Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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