Amphetamine abuse was associated with a higher risk of fatal ICH (OR, 2.63; 95% CI, 1.07 6.50). In a retro- spective analysis of patients with ICH, patients with cocaine- associated ICH had worse functional outcomes and an almost 3-fold greater risk of death during the acute hospitalization than patients with cocaine-negative ICH.727 Long-term treatment strategies, including medication, psychological counseling, and community-based programs, are effective in the management of drug dependency.706,728 According to the US Preventive Services Task Force, there is insufficient evidence to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use. Although standardized questionnaires to screen individuals for drug use/misuse have been shown to be valid and reliable, there is insufficient evidence to assess the clinical utility of these instruments when applied widely in primary care settings.729 Drug Abuse: Summary and Gaps Several drugs of abuse are associated with ischemic and hem- orrhagic stroke. There are no controlled trials demonstrating a reduction in stroke risk with abstinence. Drug Abuse: Recommendation 1. Referral to an appropriate therapeutic program is reasonable for patients who abuse drugs that have been associated with stroke, including cocaine, khat, and amphetamines (Class IIa; Level of Evidence C). Sleep-Disordered Breathing Approximately 4% of adults in the United States have sleep The diagnosis of sleep apnea is based on the apnea-hypopnea index (AHI), which describes the number of respiratory events (cessations or reductions in air flow) observed during sleep. Sleep apnea is defined as present if the AHI is 5 events per hour, and an increasing AHI indicates Several longitudinal studies have identified sleep apnea as an independent risk factor for stroke. 