title: Identifying obstructive sleep apnea after stroke/TIA: evaluating four simple screening tools.
abstract: Despite its high prevalence and unfavorable clinical consequences, obstructive sleep apnea (OSA) often remains underappreciated after cerebrovascular events. The purpose of our study was to evaluate the clinical utility of four simple paper-based screening tools for excluding OSA after stroke or transient ischemic attack (TIA).
  
  
  
  Sixty-nine inpatients and outpatients with stroke or TIA during the past 180 days completed the 4-Variable screening tool (4V), STOP-BAG questionnaire (ie, STOP-BANG questionnaire without the neck circumference measurement), Berlin questionnaire, and the Sleep Obstructive apnea score optimized for Stroke (SOS). They subsequently underwent objective testing using a portable sleep monitoring device. Cutoffs were selected to maximize sensitivity and exclude OSA (AHI ≥ 10) in ≥10% of the cohort.
  
  
  
  The mean age was 68.3 ± 14.2 years and 47.8% were male. Thirty-two patients (46.4%) were found to have OSA. Male sex, body mass index (BMI), and atrial fibrillation were independent predictors of OSA. Among the screening tools, the 4V had the greatest area under the curve (AUC) of 0.688 (p = 0.007); the sensitivity was 96.9% for a cutoff of <6. The STOP-BAG also significantly detected OSA with an AUC of 0.677 (p = 0.012); the sensitivity was 93.8% for a cutoff of <2. Scores on the 4V and STOP-BAG were significantly correlated with the AHI.
  
  
  
  The 4V and STOP-BAG questionnaire may aid clinicians with ruling out OSA within 180 days of stroke/TIA. Due to the atypical presentation of poststroke/TIA OSA, these tools are only moderately predictive; objective testing should still be used for OSA diagnosis in this population.
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada. Electronic address: mark.boulos@sunnybrook.ca.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Boulos
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Wan
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Im
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Elias
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada.
authors.forename: Fadi
authors.initials: F
authors.lastname: Frankul
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Atalla
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, School of Graduate Studies, University of Toronto, Toronto, ON, Canada.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Black
authors.affiliation: Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada.
authors.forename: Vincenzo S
authors.initials: VS
authors.lastname: Basile
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada.
authors.forename: Arun
authors.initials: A
authors.lastname: Sundaram
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Hopyan
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada.
authors.forename: Karl
authors.initials: K
authors.lastname: Boyle
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gladstone
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Murray
authors.affiliation: Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, School of Graduate Studies, University of Toronto, Toronto, ON, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Swartz
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008403:Mass Screening; D009333:Neck; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D020521:Stroke / Q000150:complications*; D011795:Surveys and Questionnaires
keywords: 4-Variable screening tool; Berlin questionnaire; Obstructive sleep apnea; STOP-BANG questionnaire; Sleep Obstructive apnea score optimized for Stroke; Stroke; Transient ischemic attack