Continuous Positive Airway Pressure: Evaluation of a Novel Therapy for Patients with Acute Ischemic Stroke

Bravata, Dawn M.; Concato, John; Fried, Terri R.; Ranjbar, Noshene; Sadarangani, Tanesh; McClain, Vincent; Struve, Frederick A.; Zygmunt, Lawrence; Knight, Herbert; Lo, Albert; Richerson, George B.; Gorman, Mark; Williams, Linda S.; Brass, Lawrence M.; Agostini, Joseph V.; Mohsenin, Vahid; Roux, Francoise; Yaggi, H. Klar

doi:10.5665/sleep.1254

Cited by 144 publications

(116 citation statements)

References 35 publications

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“…In addition to the robust literature that supports the treatment of sleep apnea in the general population,20, 21 emerging data have suggested that patients with cerebrovascular disease in the early poststroke period derive neurological benefit from the treatment of sleep apnea. Three randomized controlled trials demonstrated improvements in the NIHSS score among patients treated in the acute stroke period; however, these studies were limited by small sample sizes (ranging from 32 to 55 patients) and short follow‐ups (ranging from 8 to 90 days) 2, 4, 7. In contrast to the favorable evidence supporting the diagnosis and treatment of sleep apnea in the acute stroke or TIA period, randomized controlled trials evaluating the use of CPAP in patients with subacute and chronic stroke have reported mixed results 3, 22, 23, 24.…”

Section: Discussionmentioning

confidence: 99%

“…Sleep apnea is common among patients with acute ischemic stroke and transient ischemic attack (TIA) (60–80%),1, 2 and preliminary data have suggested that treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) may improve patient outcomes 3. Several randomized controlled studies have evaluated the use of CPAP among patients with acute ischemic stroke or TIA, but they have been limited by short follow‐up or small sample size 1, 3, 4, 5.…”

Section: Introductionmentioning

confidence: 99%

“…Two randomized trials evaluated the use of early CPAP therapy for the purpose of improving stroke severity, as measured by the National Institutes of Health (NIH) Stroke Scale (NIHSS). One trial of (N=56) patients with acute stroke demonstrated a greater improvement in NIHSS with early CPAP compared with usual care (improvement of 3.0 versus 1.0 points; P =0.03) over a 1‐month period 2. Similarly, Minnerup et al found that the NIHSS improvement was largest among patients with the greatest CPAP use over the first 8 days after stroke (improvement of 2.3 versus 1.4 points; P =0.022) 7.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

Bravata

Sico

Fragoso

et al. 2018

JAHA

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BackgroundObstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes.Methods and ResultsThis randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of OSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention‐to‐treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as‐treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, −0.6±2.9; some, −0.9±1.4; good, −0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, −0.3±1.5; some, −0.4±1.0; good, −0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0–1) versus 38% of controls (P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8).ConclusionsAlthough changes in neurological functioning and functional status were similar across the groups in the intention‐to‐treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01446913.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

Bravata

Sico

Fragoso

et al. 2018

JAHA

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“…4 There is convincing evidence that the majority of stroke patients have OSA, 5 and that early treatment with CPAP improves recovery from stroke 6 and reduces length of hospitalization. 7 Could the same be true of patients with prolonged mechanical ventilation?…”

Section: See the Original Study On Page 229mentioning

confidence: 99%

Obstructive Sleep Apnea and Prolonged Mechanical Ventilation

Johnson

2012

Respir Care

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“…Three studies either included stroke patients as the full sample or had stroke as the primary outcome [38,43,46], and one study had mortality due to stroke as a secondary outcome [46]. Two of the four studies The method of randomisation was described and that method was appropriate…”

Section: Strokementioning

confidence: 99%

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

et al. 2016

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Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulated via discussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group. @ERSpublications An overview of the research in the field of and clinical guidelines for the treatment of SDB in elderly patients

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Continuous Positive Airway Pressure: Evaluation of a Novel Therapy for Patients with Acute Ischemic Stroke

Abstract: 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.

Cited by 144 publications

References 35 publications

Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

Obstructive Sleep Apnea and Prolonged Mechanical Ventilation

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

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