Sleep apnea after stroke: Implications for screening and treatment

 描述(申请人提供)：中风是美国成年人致残的主要原因和死亡的主要原因，每年导致210亿美元的直接医疗费用。中风对少数族裔的影响不成比例，包括西班牙裔，他们中风风险更高，中风后预后更差，中风后睡眠呼吸障碍(SDB)的患病率更高。中风死亡率的下降加上美国人口老龄化，将导致残疾中风幸存者的数量急剧增加，预计拉美裔患者的增幅最大。因此，迫切需要新的方法来改善中风的结果，这在美国最大的少数民族人口拉美裔中可能尤其重要。一个关键但很少被探索的机会可能存在于卒中患者的SDB的识别和治疗中。卒中后SDB非常普遍，它的存在预示着不良的功能结局和更高的死亡率。尽管如此，很少有中风患者接受SDB的筛查或治疗。关于哪些患者卒中后可能患有高危SDB的信息很少；SDB在这种情况下的发展轨迹 以及如何预测；而且几乎没有关于拉美裔的数据。这些信息可能为改善关键的卒中后结局和缩小种族卒中差异提供机会。因此，这项研究的主要目标是1)建立卒中后SDB患者的风险分层模型，2)为卒中后SDB的发展轨迹提供新的见解，为管理决策提供信息，3)为后续临床试验的设计提供信息，该试验将评估高危SDB的治疗对卒中后关键预后的影响，以及4)探索导致拉美裔中风预后恶化的可能的可治疗原因。我们计划利用正在进行的科珀斯克里斯蒂脑攻击监测(BASIC)项目(R01 NS38916)提供的一个特殊机会。在这项以人群为基础的卒中监测研究中，所有的急性缺血性卒中患者都在基线上接受了访谈，并前瞻性地跟踪观察了3、6和12个月的结果。目前的应用程序将使用经过验证的便携式SDB筛查设备将纵向SDB评估添加到基本评估。将使用呼吸暂停/低呼吸指数以及从信号分析得出的创新措施来评估SDB的严重程度。使用BASIC提供了一个经济高效的机会，以直接影响临床护理、未来临床试验设计和健康差异的方式扩大我们对卒中后SDB的了解。

 DESCRIPTION (provided by applicant): Abstract 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.