title: Prevalence and Predictors of Sleep Apnea Risk among Ghanaian Stroke Survivors.
abstract: OBJECTIVE
  Sleep apnea (SA) has emerged as a potent risk factor for stroke recurrence and mortality. The burden of SA among stroke survivors in sub-Saharan Africa where stroke incidence and mortality are escalating is unknown. We sought to assess the prevalence of SA risk and its clinical correlates and predictors among Ghanaian stroke survivors.
  
  
  METHODS
  This cross-sectional study involved 200 consecutive stroke survivors attending a neurology clinic in a tertiary medical center in Kumasi, Ghana. The validated Berlin, STOP-BANG, and Epworth Sleepiness Scale questionnaires were administered to all eligible subjects to assess SA risk and daytime somnolence, and their demographic and clinical information, health-related quality of life, and symptoms of depression were collected using the questionnaires.
  
  
  RESULTS
  The median (interquartile range) age of stroke survivors was 62 (52-72) years and 52.5% were male. Ninety-nine (49.5%) subjects were identified as high risk for SA using the Berlin questionnaire, whereas 26 (13%), 137 (68.5%), and 37 (18.5%) subjects were classified as low, intermediate, and high risk for SA, respectively, using the STOP-BANG questionnaire. Patients at high risk of SA were significantly older, used excess alcohol, and were less able to perform activities of daily living, although their mean National Institutes of Health Stroke Scale scores were significantly lower than those with low risk for SA. None of the stroke survivors had ever been screened for SA.
  
  
  CONCLUSIONS
  One out of every 2 stroke survivors attending a neurology clinic in Ghana is at high risk for undiagnosed SA. Greater regional awareness about SA presence and outcomes among patients and providers is warranted.
authors.affiliation: Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana. Electronic address: stephensarfo78@gmail.com.
authors.forename: Fred Stephen
authors.initials: FS
authors.lastname: Sarfo
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Jenkins
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Nathaniel Adusei
authors.initials: NA
authors.lastname: Mensah
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Raelle
authors.initials: R
authors.lastname: Saulson
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Osei
authors.initials: O
authors.lastname: Sarfo-Kantanka
authors.affiliation: Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
authors.forename: Arti
authors.initials: A
authors.lastname: Singh
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Michelle
authors.initials: M
authors.lastname: Nichols
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Suparna
authors.initials: S
authors.lastname: Qanungo
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011795:Surveys and Questionnaires; D017741:Survivors
keywords: Ghana; Sleep apnea; prevalence; stroke survivors; sub-Saharan Africa