title: Unattended Hospital and Home Sleep Apnea Testing Following Cerebrovascular Events.
abstract: BACKGROUND
  Home 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).
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  There 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).
  
  
  CONCLUSIONS
  Unattended 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.
authors.affiliation: 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.
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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Black
authors.affiliation: 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.
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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, 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, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Swartz
authors.affiliation: 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.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Murray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006699:Home Care Services; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017286:Polysomnography; D011446:Prospective Studies; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000209:etiology*; D020521:Stroke / Q000150:complications*
keywords: Home sleep apnea testing; feasibility; obstructive sleep apnea; portable sleep monitoring; stroke; transient ischemic attack