Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial

Wheeler, Natalie; Wing, Jeffrey J.; O’Brien, Louise M.; Hughes, Rebecca; Jacobs, Teresa L.; Claflin, E. S.; Chervin, Ronald D.; Brown, Devin L.

doi:10.5664/jcsm.6120

Cited by 9 publications

(8 citation statements)

References 24 publications

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“…Seven primary studies of class II to IV quality using other interventions were included: one RCT using positional therapy [124], six proof-of concept studies or retrospective analyses using adaptive servo-ventilation, expiratory positive airway pressure, oxygen, transnasal insufflation, oropharyngeal muscle exercise or mirtazapine [125][126][127][128][129][130].…”

Section: Results Of the Literature Searchmentioning

confidence: 99%

“…There is very little or no evidence on the effect of specific SDB treatment alternatives, such as oropharyngeal muscle exercise [130], positional therapy [124] or mandibular advancement devices, or other positive airway pressure modes [127][128][129], oxygen [125] or pharmacotherapy [126], on stroke outcomes, cardiovascular events or mortality (table e17).…”

Section: Overview Of the Evidencementioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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Section: Results Of the Literature Searchmentioning

confidence: 99%

Section: Overview Of the Evidencementioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…However, CPAP treats OSAS but is generally poorly tolerated by stroke patients. The result of previous study on nasal expiratory positive airway pressure (EPAP) for sleep apnea after stroke shew a 33.5% decrease on AHI and a 11.4% increase on minimum SaO 2 % ( 29 ). The results of the present research (a 25.5% decrease on AHI and a 6.19% increase on minimum SaO 2 %) indicate that the effect of oropharyngeal exercise on improvement of airway obstruction seems to lower than CPAP and EPAP.…”

Section: Discussionmentioning

confidence: 99%

Oropharyngeal Muscle Exercise Therapy Improves Signs and Symptoms of Post-stroke Moderate Obstructive Sleep Apnea Syndrome

Chen

Song

et al. 2018

Front. Neurol.

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The primary aim of the current study was to assess the effects of oropharingeal muscle exercises in obstruction severity on stroke patients with OSAS. The secondary aims were to evaluate the effects of the exercises on rehabilitation of neurological function, sleeping, and morphology change of upper airway. An open-label, single-blind, parallel-group, randomized, controlled trial was designed. Fifty post-stroke patients with moderate OSAS were randomly assigned into 2 groups (25 in each group). For the therapy group, oropharyngeal muscle exercise was performed during the daytime for 20 min, twice a day, for 6 weeks. The control group was subjected to sham therapy of deep breathing. Primary outcomes were the obstruction severity by polysomnography. Secondary outcomes included recovery of motor and neurocognitive function, personal activities of daily living assessment (ADL), sleep quality and sleepiness scale. It also included upper airway magnetic resonance imaging (MRI) measurements. Assessments were made at baseline and after 6-week exercise. Finally, 49 patients completed the study. The apnea–hypopnea index, snore index, arousal index, and minimum oxygen saturation improved after exercise (P < 0.05). Oropharyngeal muscle exercises improved subjective measurements of sleep quality (P = 0.017), daily sleepiness (P = 0.005), and performance (both P < 0.05) except for neurocognition (P = 0.741). The changes in obstruction improvement, sleep characteristics and performance scale were also associated with training time, as detected by Pearson's correlation analysis. The anatomic structural remodeling of the pharyngeal airway was measured using MRI, including the lager retropalatal distance (P = 0.018) and shorter length of soft palate (P = 0.044) compared with the baseline. Hence, oropharyngeal muscle exercise is a promising alternative treatment strategy for stroke patients with moderate OSAS.Clinical Trial Registration: http://www.chictr.org.cn. Unique identifier: ChiCTR-IPR-16009970

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“…However, less than half of patients could tolerate the device [ 10 ]. Expiratory positive airway pressure (EPAP) showed better compliance but was reported to be no better than CPAP in terms of treatment effects [ 85 ]. Symptoms such as severe swallowing disorders, depression, and dementia problems in patients could help to increase their CPAP compliances [ 86 ].…”

Section: Treatment Of Bsds In Strokementioning

confidence: 99%

Sleep Disorders in Stroke: An Update on Management

2021

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Stroke is a leading cause of disability and mortality all over the world. Due to an aging population, the incidence of stroke is rising significantly, which has led to devastating consequences for patients. In addition to traditional risk factors such as age, hypertension, hyperlipidemia, diabetes and atrial fibrillation, sleep disorders, as independent modifiable risk factors for stroke, have been highlighted increasingly. In this review, we provide an overview of common types of current sleep disturbances in cerebrovascular diseases, including insomnia, hypersomnia, breathing-related sleep disorders, and parasomnias. Moreover, evidence-based clinical therapeutic strategies and pitfalls of specific sleep disorders after stroke are discussed. We also review the neurobiological mechanisms of these treatments as well as their effects on stroke. Since depression after stroke is so prevalent and closely related to sleep disorders, treatments of post-stroke depression are also briefly mentioned in this review article.

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Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial

Abstract: ClinicalTrials.gov, ID: NCT01703663.

Cited by 9 publications

References 24 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Oropharyngeal Muscle Exercise Therapy Improves Signs and Symptoms of Post-stroke Moderate Obstructive Sleep Apnea Syndrome

Sleep Disorders in Stroke: An Update on Management

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