Agreement between stroke patients and family members for ascertaining pre-stroke risk for sleep apnea.
BACKGROUND
Ascertaining self-reported information about the risk for pre-stroke obstructive sleep apnea (OSA) in the acute stroke period is challenging as many stroke patients have deficits that hinder communication. We examined agreement between stroke patients without communication limitations and family members (proxy) in the pre-stroke risk for OSA.


METHODS
Patient-proxy pairs (n=42) were interviewed independently as part of the Brain Attack Surveillance in Corpus Christi (BASIC) Project from May 2010 to April 2011. The Berlin questionnaire was used to measure a high risk for OSA defined as the presence of at least two of the following conditions: (1) snoring behaviors/witnessed apneas, (2) daytime sleepiness, and (3) hypertension or obesity. Patient-proxy agreement was assessed using a κ coefficient.


RESULTS
Forty-three percent of patients self-identified as being at high risk for sleep apnea, and 45% of proxies identified patients as high risk. Patient-proxy agreement for high risk for pre-stroke OSA was fair (κ=0.28) with better agreement for spouses and children proxies (κ=0.38) than for other family members. Agreement also was fair for most individual questions.


CONCLUSIONS
Spouse and child proxy use of the Berlin questionnaire may be an option to assess a patient's pre-stroke likelihood of sleep apnea. Whereas prospective studies of incident stroke in patients with and without objectively confirmed sleep apnea would require formidable resources, our results suggest that an alternative strategy may involve proxy use of the Berlin questionnaire in a retrospective study design.
Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States. Electronic address: sleasure@umich.edu.
Sarah L
SL
Reeves
University of Michigan Health System, Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
Devin L
DL
Brown
Michael S Aldrich Sleep Disorders Laboratory, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States.
Ronald D
RD
Chervin
Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; University of Michigan Health System, Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
Lewis B
LB
Morgenstern
University of Michigan Health System, Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
Melinda A
MA
Smith
Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; University of Michigan Health System, Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
Lynda D
LD
Lisabeth
D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D002545:Brain Ischemia / Q000453:epidemiology*; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology; D005190:Family; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011159:Population Surveillance; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D057566:Self Report; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires
Berlin questionnaire; Disparities; Ethnicity; Obstructive sleep apnea; Proxy; Stroke