An Ambulatory Treatment Pathway Expedites the Diagnosis and Treatment of Sleep Apnea after Cerebrovascular Events (P7.317)

OBJECTIVE: In patients who have sustained a cerebrovascular event, to evaluate whether an ambulatory treatment pathway can expedite the diagnosis and treatment of sleep apnea compared to previously published data in the province of Ontario, Canada. INTRODUCTION: Obstructive sleep apnea (OSA) is common and associated with poorer outcomes but remains underdiagnosed and undertreated after cerebrovascular events. Technologist-monitored, in-laboratory polysomnography is the gold standard for diagnosing OSA and titrating continuous positive airway pressure (CPAP) therapy, but lengthy wait times frequently prohibit timely assessments. Ambulatory sleep monitors are more accessible, and have been validated against in-laboratory polysomnography for the detection and treatment of OSA. METHODS: We prospectively studied 50 patients (mean age 68.5±14.0 years, 50[percnt] male, 10 with transient ischemic attack and 40 with ischemic or hemorrhagic stroke). All patients underwent testing using a level III ambulatory sleep monitor. If clinically-relevant OSA (apnea-hypopnea index [AHI] 蠅 15 or AHI 蠅 5 with a lowest nocturnal oxygen desaturation ≤88[percnt]) was detected, patients were started on an ambulatory self-adjusting CPAP device (auto-PAP) for two weeks to determine the appropriate CPAP setting, followed by initiation of standard CPAP. The times between (i) study recruitment and the ambulatory sleep study, and (ii) study recruitment and initiation of auto-PAP were computed and compared to previously published data. RESULTS: Twenty-six patients (52[percnt]) were found to have clinically-relevant OSA. From the date of recruitment, it took patients 3.5±8.7 days to complete a diagnostic ambulatory sleep study and 48.0±31.2 days to be initiated on auto-PAP. These times were substantially reduced compared to data previously reported in Ontario (4.9 months to undergo a diagnostic polysomnogram, and 11.6 months to initiate CPAP). CONCLUSIONS: Our preliminary results suggest that an ambulatory treatment pathway may expedite the diagnosis and treatment of OSA in Ontario, and increase accessibility to CPAP in patients with cerebrovascular events. Disclosure: Dr. Elias has nothing to disclose. Dr. Frankul has nothing to disclose. Dr. Im has nothing to disclose. Dr. Boyle has nothing to disclose. Dr. Black has received personal compensation for activities with Eisai Inc., Novartis, GE Healthcare, Eli Lilly, and Avid Radiopharmaceuticals as a speaker and/or consultant. Dr. Swartz has received personal compensation for activities with Bristol-Myers Squibb/Pfizer Inc. as a scientific advisory board participant. Dr. Murray has received personal compensation for activities with UCB Pharma as a consultant. Dr. Boulos has received research support from ResMed and Braebon Medical Corporation.