An Ambulatory Treatment Pathway Expedites the Diagnosis and Treatment of Sleep Apnea after Cerebrovascular Events (P7.317)
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".