Agreement between stroke patients and family members for ascertaining pre-stroke risk for sleep apnea

Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States. Electronic address: .
Sleep Medicine (Impact Factor: 3.15). 10/2013; 15(1). DOI: 10.1016/j.sleep.2013.09.010
Source: PubMed


Ascertaining self-reported information about the risk for pre-stroke obstructive sleep apnea (OSA) in the acute stroke period is challenging as many stroke patients have deficits that hinder communication. We examined agreement between stroke patients without communication limitations and family members (proxy) in the pre-stroke risk for OSA.
Patient-proxy pairs (n=42) were interviewed independently as part of the Brain Attack Surveillance in Corpus Christi (BASIC) Project from May 2010 to April 2011. The Berlin questionnaire was used to measure a high risk for OSA defined as the presence of at least two of the following conditions: (1) snoring behaviors/witnessed apneas, (2) daytime sleepiness, and (3) hypertension or obesity. Patient-proxy agreement was assessed using a κ coefficient.
Forty-three percent of patients self-identified as being at high risk for sleep apnea, and 45% of proxies identified patients as high risk. Patient-proxy agreement for high risk for pre-stroke OSA was fair (κ=0.28) with better agreement for spouses and children proxies (κ=0.38) than for other family members. Agreement also was fair for most individual questions.
Spouse and child proxy use of the Berlin questionnaire may be an option to assess a patient's pre-stroke likelihood of sleep apnea. Whereas prospective studies of incident stroke in patients with and without objectively confirmed sleep apnea would require formidable resources, our results suggest that an alternative strategy may involve proxy use of the Berlin questionnaire in a retrospective study design.

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    ABSTRACT: Background The ethnic disparity in ischemic stroke between Mexican Americans (MAs) and non-Hispanic whites (NHWs) may be partly attributable to disparities in sleep and its disorders. We therefore assessed whether pre-stroke sleep apnea symptoms (SA risk) and pre-stroke sleep duration differed between MAs and NHWs. Methods MA and NHW ischemic stroke survivors in the Brain Attack Surveillance in Corpus Christi (BASIC) project reported sleep duration, and SA symptoms on the validated Berlin questionnaire, both with respect to their pre-stroke baseline. Log binomial and linear regression models were used to test the unadjusted and adjusted (demographics, vascular risk factors) associations of high-risk Berlin scores and sleep duration with ethnicity. Results Among 862 subjects, 549 (63.7%) were MA, and 514 (59.6%) had high risk for pre-stroke SA. The MA and NHW subjects showed no ethnic difference, after adjustment for potential confounders, in pre-stroke SA risk (risk ratio [95% CI]: 1.06 [0.93,1.20]) or in pre-stroke sleep duration (on average MAs slept 2.0 fewer minutes than NHWs, 95%CI: -18.8, 14.9 minutes). Conclusions Pre-stroke SA symptoms are highly prevalent, but ethnic differences in SA risk and sleep duration appear unlikely to explain ethnic stroke disparities.
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