Comparative Effectiveness of Sleep Apnea Screening Instruments During Inpatient Rehabilitation Following Moderate to Severe TBI

Abstract

To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. Design: Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the criterion standard, attended level 1 polysomnography including encephalography. Setting: Six TBI Model System Inpatient Rehabilitation Centers. Participants: Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. Intervention: Not applicable. Main Outcome Measures: Area under the curve (AUC) of screening tools relative to total apnea hypopnea index!15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (interquartile range, 29-47). Results: The Berlin high-risk score (receiving operating curve [ROC] AUCZ0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUCZ0.780) (PZ.0211; CI, 0.018-0.223) and Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUCZ0.785) (PZ.001; CI, 0.063-0.230), both of which had comparable AUC (PZ.7245; CI, À0.047 to 0.068). Findings were similar for AHI!30 (severe apnea); however, no differences across scales was observed at

Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury

“…As part of a clinical trial partially funded by the Patient‐Centered Outcomes Research Institute (PCORI), consecutive, medically stable individuals with TBI who were enrolled in the TBI Model Systems between May 2017 and January 2019 at one of the six centers (Tampa, FL, Seattle, WA, Dallas, TX, Columbus, OH, Denver, CO, Philadelphia, PA) were recruited for this study. Full details of the cohort have been previously published 0011. Participants were at least 16 years of age and had sustained damage to brain tissue as a result of an external force.…”

“…As part of a larger study examining different measurement tools for determining sleep apnea in individuals with TBI,0011 data were collected during a single overnight sleep study on an inpatient rehabilitation ward with contemporaneous PSG and wrist actigraphy. The units used to collect ACG and PSG data were synchronized through device initiation on the same computer.…”

“…Between lights‐out and lights‐on time, 30‐second epochs of PSG data were scored for sleep stages (N1, N2, N3, REM, wake) and apneic events by one of two registered PSG technicians at a single site (Tampa, FL) according to American Academy of Sleep Medicine criteria 0014. Interrater reliability between the two scorers was high 0011. All 30‐second epochs identified as any stage of sleep (ie, N1, N2, N3, or REM) were marked as “sleep.” From these “sleep” and “wake” epochs, nightly summary statistics were calculated, including the amount of wake after sleep onset (WASO; ie, the total number of minutes of wake occurring after sleep initiation and before the final awakening), total sleep time (TST), and sleep efficiency (SE; ie, TST/time in bed calculated from the lights‐off to lights‐on interval recorded by PSG technicians).…”

“…Full details of the cohort have been previously published. 11 Participants were at least 16 years of age and had sustained damage to brain tissue as a result of an external force. Participants needed to have had an alteration of consciousness of >24 hours or a loss of consciousness >30 minutes following the TBI, or an emergency room Glasgow Coma Scale (GCS) 12 score of 3-12, or intracranial abnormalities on neuroimaging regardless of GCS score.…”

Concordance between current American Academy of Sleep Medicine and Centers for Medicare and Medicare scoring criteria for obstructive sleep apnea in hospitalized persons with traumatic brain injury: a VA TBI Model System study

“…26 To date, no study has compared the diagnostic outcome using the AASM and CMS criteria in a TBI population. Persons with moderate to severe TBI who are hospitalized with significant injury warranting inpatient rehabilitation often experience prolonged neurologic morbidity and disability, 17,[33][34][35] 36 All participating sites received institutional review board approval for conduct of the study consistent with the amended Declaration of Helsinki with consent obtained by patients or designated medical proxy using TBIMS procedures. The requirement of TBIMS enrollment at time of consent into the Patient-Centered Outcomes Research Institute-funded clinical trial was eliminated at study month 11 to allow for earlier enrollment during rehabilitation, but the clinical criteria remained unchanged.…”