The majority of acute stroke patients had sleep apnea. Auto-CPAP was well tolerated, appears to improve neurological recovery from stroke, and may represent a new therapeutic approach for selected patients with acute cerebral infarction.
Although previous studies have shown that patients with obstructive sleep apnea have a higher automobile crash rate than normal subjects, objective measurements of driving performance in patients with sleep apnea have not been reported. Therefore, we compared the driving performance of subjects with untreated, severe sleep apnea to that of control subjects on two driving simulators. Using a simulator with road films, six subjects with untreated, severe apnea performed worse than did a control group of seven normal subjects on both highway and city/rural driving (p less than 0.05). Using a personal computer program simulating a monotonous highway drive, 12 subjects with untreated sleep apnea performed worse than 12 control subjects. The patients with apnea hit a greater number of road obstacles during their 30-minute simulated drive than did the control subjects (44 +/- 52 in patients with apnea versus 9 +/- 7 in control subjects, p less than 0.05). Six patients with apnea hit fewer road obstacles after treatment with nasal continuous positive airway pressure (CPAP) than before treatment (29 +/- 19 before CPAP versus 13 +/- 8 after CPAP, p less than 0.05). We conclude that: (1) driving simulator performance of untreated subjects with severe obstructive sleep apnea is worse than that of control subjects; (2) driving simulator performance of subjects treated with nasal CPAP improves.
Background Transient ischemic attack (TIA) patients are at risk of recurrent vascular events. The primary objectives were to evaluate among TIA patients: the prevalence of sleep apnea, and among patients with sleep apnea auto-titrating continuous positive airway pressure (auto-CPAP) adherence. The secondary objective was to describe among TIA patients with sleep apnea, the recurrent vascular event rate by auto-CPAP use category. Methods All intervention patients received auto-CPAP for two nights, but only intervention patients with evidence of sleep apnea received auto-CPAP for the remainder of the 90-day period. Intervention patients received polysomnography at 90-days post-TIA. Control patients received polysomnography at baseline and at 90-days. Acceptable auto-CPAP adherence was defined as ≥4 hours/night for ≥75% nights. Vascular events included recurrent transient ischemic attack, stroke, hospitalization for congestive heart failure, myocardial infarction or death. Results We enrolled 70 acute TIA patients: intervention N=45 and control N=25. The majority of patients had sleep apnea: 57% at baseline and 59% at 90-days. Among the 30 intervention patients with airflow obstruction, 12 (40%) had acceptable auto-CPAP adherence, 18 (60%) had some use, and none had no use. Three intervention patients (12%) had recurrent events compared with 1 (2%, p=0.13) control patient. The vascular event rate was highest among sleep apnea patients with no CPAP use: none, 16%; some, 5%; acceptable adherence 0%; p=0.08. Conclusions Sleep apnea is common among acute TIA patients. It appears feasible to provide auto-CPAP in the acute TIA period. Larger studies should evaluate whether a strategy of diagnosing and treating sleep apnea can reduce recurrent vascular events after TIA.
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