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Veteran Health Indiana

 

Stroke and Sleep Apnea

Veteran patient speaks with primary care provider

Stroke, or "brain attack," is among the leading causes of death and disability in the United States. According to the American Heart Association, about 795,000 Americans suffer a stroke each year. This means that every 40 seconds somebody in the United States has a stroke.

By Indianapolis VAMC Office of Research and Development
Friday, May 30, 2014

At least half of the patients who survive a stroke or transient ischemic attack (TIA) suffer from sleep apnea. Having sleep apnea puts a patient at a higher risk of having another stroke or dying. Sleep apnea is a type of sleep disorder where the person either pauses in breathing or has shallow breathing while they sleep. Each of these pauses can last from several seconds to several minutes and can happen 5 to 30 times or more during an hour.

A safe and effective way to treat sleep apnea is through the use of continuous positive airway pressure (CPAP).  Unfortunately, few patients with stroke are screened for sleep apnea or referred for treatment with CPAP. The “Diagnosis and Treatment of Sleep Apnea in Cerebrovascular Disease” (Go To Sleep) study sent field staff to the homes of Veterans to determine if they have sleep apnea and to provide them with auto-titrating CPAP. 

The researchers, under the direction of Dr. Dawn Bravata, MD,  from the Research Service at the Indianapolis VAMC, wanted to know three things about using this strategy of sending field staff (Curt Austin and Jared Ferguson) into the homes of Veterans to diagnose and treat sleep apnea:

  • would it actually detect sleep apnea?
  • be the appropriate treatment for sleep apnea?
  • and control hypertension?

As a result of the study, it was learned that patients with strokes have a very high rate of sleep apnea, and the traditional methods of screening for sleep apnea are not useful. Home based diagnosis and treatment using portable polysomnography and auto-titrating CPAP in patients’ homes significantly improves both the diagnosis and treatment rates for sleep apnea compared with usual care. The data showed that over 90% of Veterans with TIA/stoke are currently undiagnosed with sleep apnea. 

These results suggest that all patients with a history of stroke should be tested to make the diagnosis of sleep apnea. Also, using unattended polysomnography and auto-titrating CPAP treatment is an effective way to deliver this care and does not require a facility to have an on-site sleep laboratory. 

These results are important for all VAMCs and Veterans across the nation -- those with existing sleep laboratories and those with less developed sleep medicine programs. Putting this program into all VAMCs could significantly increase the number of Veterans receiving treatment for sleep apnea and decrease the risk of death or future stroke in those patients.

 

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