Stroke is the leading cause of adult disability and a leading cause of death in the US, and results in $21 billion in direct medical costs each year. Stroke disproportionately impacts minorities including Hispanics who have higher stroke risk, poorer outcomes after stroke, and a higher prevalence of post-stroke sleep-disordered breathing (SDB). Declining stroke mortality in combination with the aging US population will result in dramatic increases in the number of disabled stroke survivors, with the largest increases projected among Hispanics. New approaches to improve stroke outcomes are therefore urgently needed, and may be particularly important among Hispanics, the largest US minority population. One critical yet scarcely explored opportunity may exist through identification and treatment of SDB in individuals with stroke. SDB is highly prevalent after stroke, and its presence predicts poor functional outcome and higher mortality. Nonetheless, very few stroke patients are screened or treated for SDB. Little information is available about which patients are likely to have high risk SDB after stroke; the trajectory of SDB in this setting and how to predict it; and almost no data are available for Hispanics. This information may offer opportunities to improve critical post-stroke outcomes and lessen ethnic stroke disparities. Thus, the main goals of the research proposed are 1) develop risk stratification models for post-stroke patients with SDB, 2) provide novel insight into the trajectory that SDB takes after stroke to inform management decisions, 3) inform the design of a subsequent clinical trial that will assess the impact of treatment of high risk SDB on key post-stroke outcomes, and 4) explore a possible treatable cause for worse stroke outcomes in Hispanics. We plan to take advantage of an exceptional opportunity provided by the ongoing Brain Attack Surveillance in Corpus Christi (BASIC) project (R01 NS38916). In this population-based stroke surveillance study in a bi-ethnic community, all acute ischemic stroke patients are interviewed at baseline and followed prospectively for 3, 6 and 12 month outcomes. The current application will add longitudinal SDB assessments to BASIC using a validated portable SDB screening device. SDB severity will be assessed with the apnea/hypopnea index, as well as innovative measures derived from signal analysis. Use of BASIC provides a cost-effective opportunity to expand our knowledge about SDB after stroke in ways that can directly impact clinical care, future clinical trial design, and health disparities.
Sleep-disordered breathing (SDB), which affects over half of stroke patients, predicts poor outcomes after stroke. Leveraging the infrastructure of the BASIC project, we propose a longitudinal, population-based study of SDB and stroke outcomes to improve the identification and management of important SDB after stroke, provide critical data to plan future clinical trials, and explore a potential target to reduce an important ethnic health disparity.
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| Gall, Seana; Phan, Hoang; Madsen, Tracy E et al. (2018) Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke. Stroke 49:531-535 |
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