0486 Performing Polysomnography in the Acute Post-stroke Setting

Abstract Introduction Despite being the leading cause of disability in adults, there are still limited treatments for ischemic stroke due to its narrow therapeutic window. Thereby, it is imperative to develop new strategies to prevent recurrent strokes and improve stroke recovery. Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is disproportionately prevalent among the stroke population, with prevalence estimates around 70%. Furthermore, many studies have established OSA as an independent risk factor for future stroke. We examined the potential benefit of bringing OSA diagnosis and therapy to the inpatient hospital setting by offering polysomnography (PSG) to stroke patients in the acute post-stroke environment. Methods Patients were recruited from the Yale New Haven Hospital, a large academic urban hospital, specifically within the following departments: Emergency Departments, Stroke units, and Neurology services. The electronic medical record was used to screen patients for various inclusion and exclusion criteria. Over the three years of active recruitment, 3,507 patients were screened. To assess the potential efficacy of this study design, the percentage of patients who were deemed eligible, who were enrolled, who received PSG, and who demonstrated a positive OSA diagnosis, were analyzed. For this study, OSA was defined as at least 15 apneas or hypopneas per hour. Results Of the 3,507 patients that were screened, 1,109 (31.6%) were deemed eligible for the study and 705 (63.6%) were approached for recruitment. Among those approached, 171 consented to participate and 107 underwent PSG testing with 97 (90.7%) demonstrating moderate or severe OSA. Conclusion The proportion of patients with sleep apnea in this study is higher than previously seen. One of the strengths of this study is the high ascertainment of PSG in the post-stroke acute setting. Additionally, the AHI cutoff of 15 events per hour likely led to an underestimation of OSA prevalence, further strengthening our findings. Limitations of this study include (1) selection bias, as patients with existing symptoms of OSA were more likely to enroll, and (2) the intentional timing of the PSG in the acute setting. This study demonstrates high rates of OSA in the acute post-stroke setting, paving the way for future interventions. Support (if any)