Introduction: Sleep apnea (SA) following stroke is present in approximately 72% of patients. SA leads to increased stroke risk and is associated with poorer prognosis. Aggressive risk factor modification after stroke is widely accepted, yet evaluation for SA is not routine practice. We hypothesized that fewer Mexican-Americans (MA) are screened for and offered SA testing following stroke than non-Hispanic whites (NHW).
Methods: Between July 2011 and May 2016, MAs and NHWs with ischemic stroke or intracerebral hemorrhage in the Brain Attack Surveillance in Corpus Christi (BASIC) project were asked during a baseline interview (a median 8 days (interquartile range=16) after presentation), if they had reported symptoms of SA to their doctor, had been asked by their doctor about SA symptoms, and if their doctor had offered formal SA testing. Logistic regression was used to test the association between ethnicity and these three outcomes unadjusted and adjusted for potential confounders such as sex, age, insurance status, and BMI.
Results: Of the 1,086 MA and 621 NHW participants, median age was 68 and 49% were women. Two hundred nineteen (20.2%) MAs self-reported symptoms of SA compared with 114 (18.4%) NHW (p=0.36). One hundred forty-seven (13.5%) MAs were asked about symptoms of SA by their doctors compared with 76 (12.2%) NHWs (p=0.44). One hundred ninety-two (17.7%) MAs were offered a SA test compared with 112 (18.0%) NHWs (p=0.86). MA ethnicity was associated with a lower odds of reporting being offered SA testing in the fully adjusted model (odds ratio 0.751 (95% CI: 0.567, 0.995)), but was not associated with the other two outcomes.
Conclusions: Screening for SA in post-stroke patients is poor overall, and worse for MAs. Given the important relationship between SA and stroke, educational interventions are needed to improve provider awareness surrounding SA screening in stroke survivors.