Abstract Introduction Obstructive sleep apnea (OSA) is common in acute ischemic stroke and may worsen secondary brain injury through hypoxia-driven autonomic and endothelial mechanisms. Although pre-stroke STOP-Bang scores can identify individuals at high baseline OSA risk, screening and treatment are often delayed due to acute-phase clinical limitations. Early bedside neurological features—particularly dysarthria and dysphagia—may further distinguish patients who require urgent OSA evaluation and intervention. This study aimed to assess whether early bulbar symptoms provide additional risk stratification value in STOP-Bang–predicted high-risk stroke patients, supporting a workflow for accelerated OSA screening and timely management. Methods We retrospectively analyzed 149 adults presenting with acute ischemic stroke within 5 days of symptom onset (November 2021–October 2023). All patients completed STOP-Bang assessment at admission, and those scoring ≥3 underwent attended in-laboratory polysomnography within 7 days of stroke onset. Patients with predominant central sleep apnea were excluded. Bulbar involvement (dysphagia/dysarthria) was classified as: none, mild symptom, or severe involvement based on clinical and three-swallow bedside dysphagia screening assessment at the study night. OSA prevalence and severity based on apnea hypopnea index(AHI) were compared across groups. Results Among the participants (mean age 60.3 ± 12.5 years, 69.8% male, BMI 25.2 ± 4.0), increasing bulbar impairment correlated with higher OSA burden. The positive predictive value for moderate OSA was 69.4%, 80.7%, and 100%, and for severe OSA 36.7%, 51.6%, and 85.7%, respectively. Mean AHI increased stepwise (26.8, 33.2, 56.8 events/h) in parallel with neurological severity. Conclusion In acute ischemic stroke patients with elevated pre-stroke STOP-Bang risk, early bulbar symptoms serve as a pragmatic bedside marker to prioritize OSA screening. This stratified model supports a clinically feasible pathway for rapid identification and earlier intervention, particularly where diagnostic capacity or PAP tolerance is restricted. Prospective validation is warranted to determine whether risk-guided, early OSA management improves neurological recovery and long-term outcomes. Support (if any)
Im et al. (Fri,) studied this question.