# Addressing Sleep Apnea Post-Stroke (ASAP)

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2020 · —

## Abstract

Background: Approximately 11,000 Veterans present to a Department of Veterans Affairs Medical Center
(VAMC) annually with ischemic stroke/transient ischemic attack (TIA). Effective secondary stroke/TIA
prevention includes delivering timely, guideline-concordant management of vascular risk factors. Over the past
decade, obstructive sleep apnea (OSA) has been recognized as a potent, underdiagnosed, and inadequately
treated risk factor for ischemic stroke. OSA is very common among patients with stroke with a prevalence of
60-70%. Despite being highly prevalent, as many as 70-80% of patients with OSA are neither diagnosed nor
treated. Untreated OSA has been associated with poor outcomes among patients with cerebrovascular
disease. OSA can be treated with a variety of approaches but the mainstay of therapy is continuous positive
airway pressure (CPAP). CPAP has been shown to improve neurological symptoms and functional status
among post-stroke patients with OSA, especially when applied early post-stroke. Current stroke/TIA prevention
guidelines recommend diagnosing and treating OSA among stroke patients; however, few patients within the
Veterans Health Administration (VHA) receive guideline concordant evaluation and management.
Objective: Utilizing a Hybrid Type I, randomized, stepped-wedge trial at 6 diverse VAMCs, to implement and
evaluate the effectiveness and sustainability of implementation strategies utilized in an Addressing Sleep
Apnea Post-stroke (ASAP) program designed to improve diagnosis and management of OSA.
Methods: We will initiate the ASAP program at 6 VAMCs that annually care for at least 50 Veterans admitted
with a stroke but without a known history of OSA for a fourteen-month intervention period followed by a
sustainability period. Effectiveness of the intervention will be measured across two primary (facility-level
diagnostic rate and 90-day recurrent vascular event rate) and three secondary domains (treatment rate, PAP
adherence, and 90-day all-cause readmission rate). ASAP protocol will include a systems redesign virtual
collaborative and data monitoring; implementation strategies will include local adaptation, champions, external
facilitation, and audit and feedback. The Consolidated Framework for Implementation Research (CFIR) will be
used to evaluate the implementation of the intervention and of the implementation strategies at baseline, at the
end of the one-year intervention period, and at the end of the sustainability period. We will construct a business
case analysis at the facility-level, including financial components related to the intervention.
Hypothesis: We believe that we can implement a sustainable ASAP program across diverse VAMCs which: (1)
improves OSA diagnosis, treatment, and 90-day recurrent vascular event rate, and; (2) has a business case
favoring intervention sites with the highest baseline recurrent vascular event rate.
Conclusion and next steps: Interventions that improve diagnosis and management of OSA...

## Key facts

- **NIH application ID:** 9716768
- **Project number:** 1I01HX002324-01A2
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Dawn Marie Bravata
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9716768

## Citation

> US National Institutes of Health, RePORTER application 9716768, Addressing Sleep Apnea Post-Stroke (ASAP) (1I01HX002324-01A2). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9716768. Licensed CC0.

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