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(Stroke. 2005;36:1293.)
© 2005 American Heart Association, Inc.

Research Reports

Editorial Comment: How Much Is a Good Night’s Sleep Worth?

Linda S. Williams, MD Robert G. Holloway, MD, MPH

Health Services Research and Development, Roudebush VAMC, and, Department of Neurology, Indiana University School of Medicine, Indianapolis, Ind
Neurology and Community & Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY

An extract of the first 250 words of the full text is provided, because this article has no abstract.

As Brown et al point out in this issue of Stroke, sleep disordered breathing is associated both with increased stroke risk and increased poststroke morbidity and mortality.¹ Obstructive sleep apnea (OSA) is common after stroke, occurring in as many as 60 to 90% of patients, although the natural history of OSA in stroke patients, especially when OSA is first identified during the acute hospitalization, is not well studied. Because effective treatment, namely continuous positive airway pressure (CPAP), is effective at reducing sleep apnea and has been shown in small studies to be feasible in stroke patients, it is reasonable to consider planning trials to evaluate whether CPAP can improve stroke outcomes and reduce subsequent vascular events.

The authors used decision–analytic modeling to identify the magnitude of benefit that identification and treatment of OSA would need to demonstrate to be considered cost-effective. They estimated the magnitude of benefit of screening and treatment of OSA by using quality-adjusted life years (QALYs), a metric that combines one’s preference for a health state with the time that one lives in that health state. They estimated the cost-effectiveness by calculating an incremental cost-effectiveness ratio or the extra costs to screen and treat OSA compared to not screen and treat to gain QALYs. Although the level at which a treatment is considered cost-effective varies, in the US interventions that cost less than $100 000 to $200 000 per QALY are typically considered cost-effective.²

As far as decision–analytic models go, this model is simple and thus . . . [Full Text of this Article]