• Mark I Boulos, Sara Elias, Anthony Wan, James Im, Fadi Frankul, Mina Atalla, Sandra E Black, Vincenzo S Basile, Arun Sundaram, Julia J Hopyan, Karl Boyle, David J Gladstone, Richard H Swartz, and Brian J Murray.
• Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada. Electronic address: mark.boulos@sunnybrook.ca.
• J Stroke Cerebrovasc Dis. 2017 Jan 1; 26 (1): 143-149.

BackgroundHome sleep apnea testing (HSAT) is an alternative to polysomnography for the detection of obstructive sleep apnea (OSA). We assessed the feasibility of HSAT as an unattended screening tool for patients with a stroke or transient ischemic attack (TIA).AimsThe primary outcome was the feasibility of unattended HSAT, as defined by analyzability of the data. Secondary outcomes included determining (1) predictors of obtaining nonanalyzable sleep data and (2) time to OSA detection and continuous positive airway pressure (CPAP) initiation.MethodsIn this single-center prospective observational study, inpatients or outpatients who had sustained a stroke or TIA were screened for OSA using the ApneaLink Plus ambulatory sleep monitor in their home or hospital room.ResultsThere were 102 patients who completed unattended sleep monitoring. Mean age was 68.7 ± 13.7 years, 55.9% were male, 57.8% were outpatients, and 77.5% had a stroke (22.5% with TIA). Eighty-two (80.4%) patients obtained four or more hours of analyzable sleep data. Functional dependence (defined as a modified Rankin Scale of >2) and elevated body mass index were independently associated with obtaining nonanalyzable data. OSA was detected in 63.4% (52 of 82) of patients and, of those, 34 of 52 (65.4%) initiated CPAP therapy. The mean time from study recruitment to HSAT was 1.7 days (median: 1, interquartile range [IQR]: 2) and CPAP was initiated on average within 62.7 days of recruitment (median: 53, IQR: 30).ConclusionsUnattended HSAT can be feasibly implemented after stroke or TIA. This method facilitates rapid diagnosis and management of OSA in both the outpatient and inpatient settings.Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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