Diagnosis and Treatment of Sleep Apnea in Patients' Homes: The Rationale and Methods of the “GoToSleep” Randomized-Controlled Trial

Bravata, Dawn M.; Ferguson, Jared; Miech, Edward J.; Agarwal, Rajiv; McClain, Vincent; Austin, Charles; Struve, Frederick A.; Foresman, Brian H.; Li, Xinli; Wang, Zhu; Williams, Linda S.; Dallas, Mary I.; Couch, Cody D; Sico, Jason J.; Fragoso, Carlos A. Vaz; Matthias, Marianne S.; Chumbler, Neale R.; Myers, Jamie L.; Burrus, Nicholas; Dube, Archana; French, Dustin D.; Schmid, Arlene A.; Concato, John; Yaggi, H. Klar

doi:10.5664/jcsm.1654

Cited by 19 publications

(20 citation statements)

References 57 publications

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“…73 Such studies could also reveal a predictive model for the BP response to effective OSA treatment, especially because the average BP decrease obtained with OSA treatment has been modest, yet “responder” patients manifest substantial BP improvements. The increased power of longitudinal trials using well designed portable therapeutic systems could also help shed further light on the controversy regarding the degree to which age, obesity, and other co-morbidities explain the increased prevalence of HTN and HTN-related adverse outcomes among patients with OSA, and how life-style modifications fit into the complex interactions between OSA and BP.…”

Section: Resultsmentioning

confidence: 99%

Obstructive Sleep Apnea and Hypertension

2014

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Section: Resultsmentioning

confidence: 99%

Obstructive Sleep Apnea and Hypertension

2014

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“…Data for the current study were collected as part of a prospective longitudinal randomized trial focused on sleep apnea identification and management among veterans with a history of cerebrovascular disease and hypertension [12]. The methods of the clinical trial have been described elsewhere [12].…”

Section: Designmentioning

confidence: 99%

“…The methods of the clinical trial have been described elsewhere [12]. As part of this trial, participants were contacted at least every other month for the 1 yr study period to inquire about adverse events.…”

Section: Designmentioning

confidence: 99%

Circumstances and consequences of falls among people with chronic stroke

et al. 2013

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Abstract-Falls are common after stroke; however, circumstances and consequences are relatively unknown. Our objectives were to identify the differences between fallers and non-fallers among people with chronic stroke, identify the circumstances of fall events, and examine the consequences of the falls. This is a secondary data analysis; all participants included sustained a stroke. Variables included demographics, stroke characteristics, and comorbidities. Falls were collected via self-report, and circumstances and consequences were derived from participant description of the event and categorized as appropriate. Among 160 participants, 53 (33%) reported a fall during the 1 yr period. Circumstances of falls were categorized as intrinsic or extrinsic. Location and circumstance of the fall were included: 70% occurred at home and 40% were associated with impaired physical or mental state (e.g., inattention to tying shoes). Additionally, 21% of falls were associated with activities of daily living and mobility and 34% with slips or trips. The majority who fell sustained an injury (72%). Injuries ranged from bruising to fractures, and 55% of those with an injury sought medical care (32% to emergency department). Poststroke falls are associated with an alarming rate of injury and healthcare utilization. Targeting mental and physical states may be key to fall prevention.

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“…11,12 A clinical prediction model was developed and validated. Results across different OSA prediction instruments were compared.…”

Section: Methodsmentioning

confidence: 99%

Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea

Sico

Yaggi

Ofner

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background Screening instruments for obstructive sleep apnea (OSA), as used routinely to guide clinicians regarding patient referral for polysomnography (PSG), rely heavily on symptomatology. We sought to develop and validate a cerebrovascular disease-specific OSA prediction model less reliant on symptomatology, and to compare its performance with commonly used screening instruments within a population with ischemic stroke or transient ischemic attack (TIA). Methods Using data on demographic factors, anthropometric measurements, medical history, stroke severity, sleep questionnaires, and PSG from 2 independently derived, multisite, randomized trials that enrolled patients with stroke or TIA, we developed and validated a model to predict the presence of OSA (i.e., Apnea-Hypopnea Index ≥5 events per hour). Model performance was compared with that of the Berlin Questionnaire, Epworth Sleepiness Scale (ESS), the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender instrument, and the Sleep Apnea Clinical Score. Results The new SLEEP Inventory (Sex, Left heart failure, ESS, Enlarged neck, weight [in Pounds], Insulin resistance/ diabetes, and National Institutes of Health Stroke Scale) performed modestly better than other instruments in identifying patients with OSA, showing reasonable discrimination in the development (c-statistic .732) and validation (c-statistic .731) study populations, and having the highest negative predictive value of all in struments. Conclusions Clinicians should be aware of these limitations in OSA screening instruments when making decisions about referral for PSG. The high negative predictive value of the SLEEP INventory may be useful in determining and prioritizing patients with stroke or TIA least in need of overnight PSG.

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Diagnosis and Treatment of Sleep Apnea in Patients' Homes: The Rationale and Methods of the “GoToSleep” Randomized-Controlled Trial

Cited by 19 publications

References 57 publications

Obstructive Sleep Apnea and Hypertension

Obstructive Sleep Apnea and Hypertension

Circumstances and consequences of falls among people with chronic stroke

Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea

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