Diagnosis and treatment of sleep apnea in patients' homes: The rationale and methods of the "GoToSleep" randomized-controlled trial

Dawn Bravata, Jared Ferguson, Edward Miech, Rajiv Agarwal, Vincent McClain, Charles Austin, Frederick Struve, Brian Foresman, Xinli Li, Zhu Wang, Linda Williams, Mary I. Dallas, Cody D. Couch, Jason Sico, Carlos Fragoso, Marianne Matthias, Neale Chumbler, Jennifer Myers, Nicholas Burrus, Archana DubeDustin D. French, Arlene A. Schmid, John Concato, H. Klar Yaggi

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The "Diagnosis and Treatment of Sleep Apnea in Cerebrovascular Disease" (GoToSleep) study is evaluating a strategy to improve the diagnosis and treatment of sleep apnea among veterans with stroke or transient ischemic attack (TIA) who also have hypertension. Specifically, the GoToSleep study was designed to overcome some of the barriers that exist within the Veterans Health Administration (VHA) to the timely diagnosis and treatment of sleep apnea by using ambulatory home-based polysomnography and auto-titrating continuous positive airway pressure (CPAP) to reduce the reliance on laboratory-based sleep studies. Methods: The GoToSleep study is a prospective, multi-site, randomized, controlled strategy trial among an expected 318 veterans with cerebrovascular disease and hypertension who are assigned to an intervention group or a control group. Patients in the intervention group receive unattended polysomnography at baseline, and those with sleep apnea receive autotitrating CPAP therapy for up to one year. Patients in the control group receive usual care and unattended polysomnography at the end of the study to identify the rate of undiagnosed sleep apnea. The primary objectives of the GoToSleep study are to determine whether a diagnostic and therapeutic intervention strategy among veterans with cerebrovascular disease and hypertension improves: (1) detection of sleep apnea; (2) appropriate treatment for sleep apnea; and (3) control of hypertension. Twenty-four-hour blood pressure assessments are made at baseline and at the end of the one-year study period for both groups. Antihypertensive medications and their doses are recorded at the time of the 24-hour blood pressure measurements. Discussion: This manuscript provides the rationale for 4 key components of the design of the GoToSleep trial: the inclusion of patients with cerebrovascular disease and hypertension without the use of a measure of daytime sleepiness as an eligibility criterion; the use of portable polysomnography and auto-titrating CPAP in patients' homes rather than using sleep laboratory polysomnography with fixed pressure CPAP; the analytic approach to evaluating change in blood pressure in the context of change in antihypertensive medications; and the use of a usual care control group.

Original languageEnglish
Pages (from-to)27-35
Number of pages9
JournalJournal of Clinical Sleep Medicine
Volume8
Issue number1
DOIs
StatePublished - 2012

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Sleep Apnea Syndromes
Polysomnography
Randomized Controlled Trials
Cerebrovascular Disorders
Continuous Positive Airway Pressure
Hypertension
Veterans
Blood Pressure
Control Groups
Antihypertensive Agents
Therapeutics
Sleep
Veterans Health
United States Department of Veterans Affairs
Transient Ischemic Attack
Stroke
Pressure

Keywords

  • Brain ischemia
  • Hypertension
  • Sleep apnea

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Diagnosis and treatment of sleep apnea in patients' homes : The rationale and methods of the "GoToSleep" randomized-controlled trial. / Bravata, Dawn; Ferguson, Jared; Miech, Edward; Agarwal, Rajiv; McClain, Vincent; Austin, Charles; Struve, Frederick; Foresman, Brian; Li, Xinli; Wang, Zhu; Williams, Linda; Dallas, Mary I.; Couch, Cody D.; Sico, Jason; Fragoso, Carlos; Matthias, Marianne; Chumbler, Neale; Myers, Jennifer; Burrus, Nicholas; Dube, Archana; French, Dustin D.; Schmid, Arlene A.; Concato, John; Yaggi, H. Klar.

In: Journal of Clinical Sleep Medicine, Vol. 8, No. 1, 2012, p. 27-35.

Research output: Contribution to journalArticle

Bravata, D, Ferguson, J, Miech, E, Agarwal, R, McClain, V, Austin, C, Struve, F, Foresman, B, Li, X, Wang, Z, Williams, L, Dallas, MI, Couch, CD, Sico, J, Fragoso, C, Matthias, M, Chumbler, N, Myers, J, Burrus, N, Dube, A, French, DD, Schmid, AA, Concato, J & Yaggi, HK 2012, 'Diagnosis and treatment of sleep apnea in patients' homes: The rationale and methods of the "GoToSleep" randomized-controlled trial', Journal of Clinical Sleep Medicine, vol. 8, no. 1, pp. 27-35. https://doi.org/10.5664/jcsm.1654
Bravata, Dawn ; Ferguson, Jared ; Miech, Edward ; Agarwal, Rajiv ; McClain, Vincent ; Austin, Charles ; Struve, Frederick ; Foresman, Brian ; Li, Xinli ; Wang, Zhu ; Williams, Linda ; Dallas, Mary I. ; Couch, Cody D. ; Sico, Jason ; Fragoso, Carlos ; Matthias, Marianne ; Chumbler, Neale ; Myers, Jennifer ; Burrus, Nicholas ; Dube, Archana ; French, Dustin D. ; Schmid, Arlene A. ; Concato, John ; Yaggi, H. Klar. / Diagnosis and treatment of sleep apnea in patients' homes : The rationale and methods of the "GoToSleep" randomized-controlled trial. In: Journal of Clinical Sleep Medicine. 2012 ; Vol. 8, No. 1. pp. 27-35.
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AU - Agarwal, Rajiv

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AU - Austin, Charles

AU - Struve, Frederick

AU - Foresman, Brian

AU - Li, Xinli

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AU - Dallas, Mary I.

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AU - Sico, Jason

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AU - Myers, Jennifer

AU - Burrus, Nicholas

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