Summary: Researchers at WVU Medicine and the WVU School of Medicine have identified high-resolution pulse oximetry as a feasible, cost-effective method to screen for sleep-disordered breathing, including sleep apnea, in stroke patients. In a study of 96 ischemic stroke patients, 34% were found to have sleep-disordered breathing, with those affected facing a 2.7-fold increased risk of worse neurological outcomes during hospitalization. Despite this finding, many high-risk patients did not receive follow-up or treatment, highlighting the need for improved access to care in rural areas like Appalachia. The research team is now developing a prospective trial to further examine the impact of early detection and treatment of sleep-disordered breathing in stroke patients.
Key Takeaways:
- New Screening Tool Identified: WVU researchers found that high-resolution pulse oximetry is a practical and cost-effective way to screen stroke patients for sleep apnea, addressing a critical gap in early detection.
- High Risk of Worse Outcomes: Patients with sleep-disordered breathing were 2.7 times more likely to experience worse neurological outcomes during hospitalization, underscoring the importance of early diagnosis and treatment.
- Follow-Up Care Lacking: Despite the identification of high-risk patients, few received adequate follow-up and treatment, illustrating the need to improve access to sleep apnea care in rural healthcare settings.
Researchers at WVU Medicine and the WVU School of Medicine have identified high-resolution pulse oximetry as a feasible tool for detecting sleep-disordered breathing in acute stroke patients.
A recent study, published in Sleep and Breathing, highlights the need to address sleep-disordered breathing conditions like sleep apnea, which remain underdiagnosed and undertreated, especially in the Appalachia region. However, untreated sleep apnea may lead to stroke or recurrence of stroke.
“This is due to both under-recognition as an independent risk factor for vascular disease, as well as the logistics needed to adequately diagnose and ultimately treat patients,” says Amelia Adcock, MD, neurologist at the WVU Rockefeller Neuroscience Institute and co-author of the study, in a release. “The objective of our efforts is to change the status quo. We aim to successfully identify acute stroke patients who are at high risk for obstructive sleep apnea and ensure they have access to appropriate treatment.”
High Resolution-Pulse Oximetery to Screen for Sleep Apnea
A team of WVU researchers led by Sunil Sharma, MD, chief of pulmonary, critical care, and sleep medicine, tested the feasibility of a cost-effective and simple device called a high-resolution pulse oximeter to screen for sleep apnea in patients admitted to WVU Medicine hospitals.
The study screened 96 patients with mild-to-moderate ischemic stroke within 48 hours of admission, using overnight high-resolution pulse oximetry to detect sleep-disordered breathing based on oxygen desaturation index levels. Results showed that 34% of patients had sleep-disordered breathing, and these individuals were 2.7 times more likely to experience worse neurological outcomes during hospitalization compared to those without sleep-disordered breathing.
“The findings address the first barrier to diagnosis of sleep apnea in patients admitted with acute stroke,” Sharma says in a release. “This cost-effective strategy can be implemented in any hospital taking care of acute stroke populations and determine if it is playing a role in worsening their comorbidities.”
Lack of Follow-Up
Researchers note that few of the high-risk sleep-disordered breathing patients successfully identified in the study received adequate follow-up and treatment. Adcock says this clear disconnect between disease and treatment illustrates the lack of access to appropriate sleep-disordered breathing treatment.
“Our findings demonstrate the urgency to develop strategies to overcome these barriers and facilitate sleep-disordered breathing treatment,” she says in a release. “Sleep-disordered breathing is a reversible and treatable vascular risk factor. Successful treatment will directly mitigate an individual patient’s risk for subsequent vascular events.”
“This highlights the challenges of rural healthcare disparities, which are multi-layered with other barriers like access to healthcare, low literacy, and poverty,” Sharma adds in a release.
The research team is now designing a prospective trial to further study outcomes among patients with sleep-disordered breathing and factors that predict successful treatment. The trial will address the next barrier to getting patients to get diagnosed and treated post-discharge and study whether extending the service to the stroke unit would help close the gap of early detection and therapy.
