Pulse oximetric routine examination of sleep apnea in acute stroke (PRESS)

Abstract

Background: Sleep-disordered breathing (SDB) is present in more than 70% of stroke patients. Despite its association with increased morbidity, mortality, and reduced functional outcomes, targeted assessment of SDB in stroke patients, remain controversial. Polysomnography ("gold standard" examination) is a technically demanding and costly test with limited availability. The use of screening questionnaires is limited due to low specificity and sensitivity. Pulse oximetry seems to be a sensible alternative. Our study aimed to assess the feasibility and predictive value of routine pulse oximetric screening for assessment of SDB in patients with acute stroke.

Methods: Patients with acute stroke were enrolled in an open, prospective study. A single-night pulse oximetric assessment was used for SDB screening. Subsequently, polysomnography was performed to confirm SDB. Moderate-to-severe SDB was defined as apnea-hypopnea index ≥15.

Results: Out of 420 enrolled patients, refusal to undergo examination was reported in 4 and non-cooperation during the investigation in 21 subjects. The area under the curve in a receiver operating curve to predict moderate-to-severe SDB by desaturation index (DI) was 0.86 (95% CI: 0.76-0.97), and optimal DI cut-off by Youden index was 15.3. Positive pulse oximetric screening (DI ≥ 15.3) had 90.5% sensitivity and 75% specificity to predict moderate-to-severe SDB.

Conclusions: Our results suggest a good adherence of acute stroke patients to the pulse oximetric screening. Pulse oximetry represents a simple, cost-effective, and sensitive examination that might be used in stroke patients as an appropriate tool for further selection for targeted diagnostic and therapeutic processes of SDB in the sleep laboratory.

Keywords: Feasibility; Pulse oximetry; Screening; Sensitivity; Sleep-disordered breathing; Stroke.