Background: Assessing sleep-disordered breathing (SDB) in aged or disabled populations is difficult. Aims: To validate a multivariable apnea risk prediction index (MAPI) in stroke survivors and estimate SDB prevalence (apnea-hypopnea index ≧10) in a community-based stroke cohort. Methods: Self-reported sleep apnea symptoms, demographic and anthropometric data were obtained from a hospital-based (SCOPES II, n = 152) and a community-based (NEMESIS, n = 431) cohort at about 3 years after stroke. Logistic regression models for prediction of SDB using the MAPI were validated with home-based nocturnal polygraphic data recordings obtained in 74 SCOPES II participants. Results: NEMESIS subjects (median age 76, females 45%) were older than SCOPES II subjects (median age 70, females 42%). SDB prevalence was 44.9% in the nocturnal polygraphy subset, and estimated as 44.1% (SCOPES II) and 50.6% (NEMESIS) using a modified MAPI. Conclusion: The MAPI can be reliably used in stroke cohorts and SDB affects about half of chronic stroke survivors.

Keywords:
Stroke, Sleep disorders, Validation studies
1.
Tishler PV, Larkin EK, Schluchter MD, Redline S: Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003;289:2230–2237.
2.
Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG: Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829–1836.
3.
Arzt M, Young T, Finn L, Skatrud JB, Bradley TD: Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005;172:1447–1451.
4.
Munoz R, Duran-Cantolla J, Martínez-Vila E, Gallego J, Rubio R, Aizpuru F, De La Torre G: Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 2006;37:2317–2321.
5.
Cadilhac DA, Thorpe RD, Pearce DC, Barnes M, Rochford PD, Tarquinio N, Davis SM, Donnan GA, Pierce RJ, SCOPES II Study Group: Sleep disordered breathing in chronic stroke survivors. A study of the long term follow-up of the SCOPES cohort using home based polysomnography. J Clin Neurosci 2005;12:632–637.
6.
Thrift AG, Dewey HM, Macdonell RA, McNeil JJ, Donnan GA: Stroke incidence on the east coast of Australia: the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2000;31:2087–2092.
7.
Dew MA, Hoch CC, Buysse DJ, Monk TH, Begley AE, Houck PR, Hall M, Kupfer DJ, Reynolds CF 3rd: Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med 2003;65:63–73.
8.
Rowley JA, Aboussouan LS, Badr S: The use of clinical prediction formulas in the evaluation of obstructive sleep apnea. Sleep 2000;23:929–937.
9.
Maislin G, Pack AI, Kribbs NB, Smith PL, Schwartz AR, Kline LR, Schwab RJ, Dinges DF: A survey screen for prediction of apnea. Sleep 1995;18:158–166.
10.
Cadilhac DA, Ibrahim J, Pearce DC, Ogden KJ, McNeill J, Davis SM, Donnan GA, SCOPES Study Group: Multicenter comparison of processes of care between Stroke Units and conventional care wards in Australia. Stroke 2004;35:1035–1040.
11.
Dingli K, Coleman E, Vennelle M, Flinch S, Wraith P, Mackay T, Douglas NJ: Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 2003;21:253–259.
12.
Marshall RJ: Validation study methods for estimating exposure proportions and odds ratios with misclassified data. J Clin Epidemiol 1990;43:941–947.
13.
Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F O’Connor GT, Boland LL, Schwartz JE, Samet JM: Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;163:19–25.
14.
Parra O, Arboix A, Bechich S, García-Eroles L, Montserrat JM, López JA, Ballester E, Guerra JM, Sopeña JJ: Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 2000;161:375–380.
15.
Basseti CL, Milena M, Gugger M: Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke 2006;37:967–972.
16.
Bixler EO, Vgontzas AN, Have TT, Tyson K, Kales A: Effects of age on sleep apnea in men. I. Prevalence and severity. Am J Respir Crit Care Med 1998;157:144–148.
17.
Duran J, Esnaola S, Rubio R, Iztueta A: Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30–70 years. Am J Respir Crit Care Med 2001;163:685–689.
18.
Mohsenin V: Sleep-related breathing disorders and risk of stroke. Stroke 2001;32:1271–1278.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.