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

Šiarnik, Pavel; Jurík, Matúš; Veverka, Jakub; Klobučníková, Katarína; Kollár, Branislav; Turčãni, Peter; Sýkora, Marek

doi:10.1016/j.sleep.2020.06.035

Cited by 8 publications

(11 citation statements)

References 16 publications

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“…Our findings suggest that strategies to augment adherence to PAP therapy are needed in stroke patients. Despite good adherence of the patients with acute stroke to the pulse oximetric screening, reported in our previous study [ 11 ], a relatively high proportion of the PAP candidates (17 out of 116) refused to undergo further diagnostic and therapeutic workup. Similarly, a high proportion of the patients who underwent polysomnography and were indicated for PAP therapy (9 out of 45) refused PAP therapy immediately after titration polysomnography despite a detailed explanation of untreated SDB risks and therapy principles by a sleep specialist.…”

Section: Discussionmentioning

confidence: 93%

“…As previously described, within the PRESS (pulse oximetric routine examination of sleep apnea in acute stroke) study, 297 consecutive acute stroke subjects hospitalized in the First Department of Neurology, Comenius University, Bratislava, underwent routine sleep apnea screening from March 2019 to February 2020 [ 11 ]. A subpopulation with imaging-confirmed acute ischemic stroke (using computerized tomography or magnetic resonance imaging) was chosen for further study.…”

Section: Methodsmentioning

confidence: 99%

“…PAP candidate was defined by a desaturation index ≥ 15.3/h (desaturation defined as a decrease of oxygen saturation > 3% lasting > 10 s). We used a cut-off point of 15.3/h that had a 90.5% sensitivity to predict stroke subjects with moderate-to-severe sleep apnea in our previous study [ 11 ]. Further diagnostic workup of PAP candidates included standard overnight polysomnography in a sleep laboratory setting.…”

Section: Methodsmentioning

confidence: 99%

“…Colelli et al revealed 52% adherence with PAP therapy after outpatient titration at a 6-month follow-up visit [ 10 ]. Based on the results of our previous study [ 11 ], this study aimed to determine PAP adherence in patients undergoing comprehensive sleep apnea assessment and in-lab PAP titration in the early subacute phase of stroke. The main difference between the current study and previously mentioned studies is the prospective selection of possible PAP candidates based on the results of routine sleep apnea assessment in stroke subjects [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Adherence to positive airway pressure therapy initiated in the early subacute phase of ischemic stroke: a PRESS study follow-up

et al. 2022

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Background Sleep-disordered breathing (SDB) is frequent in stroke patients and negatively affects stroke outcomes. Positive airway pressure (PAP) is the standard first-line treatment for patients with moderate-to-severe SDB. Despite a strong link between PAP adherence and therapeutic response, rates of post-stroke PAP adherence remain underexplored. Our study aimed to determine PAP adherence in patients undergoing comprehensive sleep apnea assessment and in-lab PAP titration in the early subacute phase of stroke. Methods In-hospital screening pulse oximetry was performed in consecutive patients with imaging-confirmed acute ischemic stroke. Subjects with desaturation index ≥ 15.3/h were selected as PAP candidates, and polysomnography was recommended. In a sleep laboratory setting, subjects underwent a diagnostic night followed by a titration night, and PAP therapy was initiated in subjects with apnea–hypopnea index ≥ 15/h. Adherence to PAP therapy was assessed at a 6-month follow-up visit. Results Of 225 consecutive patients with acute ischemic stroke, 116 were PAP candidates and 52 were able to undergo polysomnography. PAP therapy was initiated in 35 subjects. At a 6-month follow-up visit, out of 34 stroke survivors, PAP adherence (PAP use of > 4 h per night) was present in 47%. Except for the significantly lower minimal nocturnal O 2 saturation determined from the polysomnography (74.6 ± 11.7% vs. 81.8 ± 5.2%, p = 0.025), no other significant difference in characteristics of the groups with PAP adherence and PAP non-adherence was found. Conclusions Less than half of the stroke subjects remained adherent to PAP therapy at 6 months post-PAP initiation. Special attention to support adaptation and adherence to PAP treatment is needed in this group of patients.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adherence to positive airway pressure therapy initiated in the early subacute phase of ischemic stroke: a PRESS study follow-up

et al. 2022

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“…Several studies proved overnight pulse oximetry is a simple method to evaluate nocturnal desaturations in patients with stroke [ 11 , 12 , 13 ]. This method can be used as a sensitive screening tool in this population [ 14 , 15 , 16 ]. This study aimed to explore and compare the severity of nocturnal desaturations in a “real world” population of patients with acute WUS and non-WUS.…”

Section: Introductionmentioning

confidence: 99%

No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results

Klobučníková

Kollár

Jurík

et al. 2023

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Background: Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in the pathophysiology of WUS is still insufficiently explored. According to several studies, patients with WUS have a significantly more severe sleep apnea syndrome and lower mean blood oxygen saturation. This study aimed to assess the severity of nocturnal desaturations in acute WUS and non-WUS patients using nocturnal pulse oximetry. Material and Methods: The cohort of 225 consecutive patients with neuroimaging-verified acute cerebral ischemia was prospectively enrolled. For further analyses, 213 subjects with known WUS/non-WUS status were selected (111 males and 102 females, average age 70.4 ±12.9, median baseline NIHSS = 5, median baseline mRS = 3). Patients were divided into the WUS group (n = 45) and the non-WUS group (n = 168). Overnight pulse oximetry was performed within 7 days of the stroke onset and data of both of the studied groups were compared. Results: We found oxygen desaturation index (ODI) in the WUS group was 14.5 vs. 16.6 (p = 0.728) in the non-WUS group, basal O2 saturation was 92.2% vs. 92.5% (p = 0.475), average low O2 saturation was 90.3% vs. 89.6% (p = 0.375), minimal O2 saturation was 79.5% vs. 80.6% (p = 0.563), and time with O2 saturation <90% (T90) was 4.4% vs. 4.7% (p = 0.729). Conclusions: In the studied sample, monitored respiratory parameters including ODI, basal O2 saturation, average low O2 saturation, minimal O2 saturation, and T90 did not significantly differ between groups of WUS and non-WUS patients.

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