title: A screening tool for obstructive sleep apnea in cerebrovascular patients.
abstract: A majority of stroke patients suffer from obstructive sleep apnea (OSA), which can go unrecognized as the current OSA screens do not perform well in stroke patients. The objective of this study is to modify the existing OSA screening tools for use in stroke patients.
  
  
  
  The cohort study consisted of patients who completed the validated OSA STOP screen and underwent polysomnography within one year. Six prediction models were created and sensitivity and specificity of various cut points were calculated.
  
  
  
  There were 208 patients with mean age of 55.4 years; 61.0% had sleep apnea. Models with the highest c-statistics included the STOP items plus BMI, age, and sex (STOP-BAG). Addition of neck circumference and other variables did not significantly improve the models. The STOP-BAG2 model, using continuous variables, had a greater sensitivity of 0.94 (95% CI 0.89-0.98) and specificity 0.60 (95% CI 0.49-0.71) compared to the STOP-BAG model, which used dichotomous variables, and had a sensitivity of 0.91 (95% CI 0.85-0.96) and specificity of 0.48 (95% CI 0.37-0.60).
  
  
  
  The STOP-BAG screen can be used to identify cerebrovascular patients at an increased risk of OSA. The use of continuous variables (STOP-BAG2) is preferable if automated score calculation is available. It can improve the efficiency of evaluation for OSA and lead to improved outcomes of patients with cerebrovascular disease.
authors.affiliation: Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, USA; Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA. Electronic address: katzani@ccf.org.
authors.forename: Irene L
authors.initials: IL
authors.lastname: Katzan
authors.affiliation: Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Thompson
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.affiliation: Sleep Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Foldvary-Schaefer
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D002561:Cerebrovascular Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires
keywords: Cerebrovascular disease; Diagnosis; Obstructive sleep apnea