Auto-Titrating Continuous Positive Airway Pressure for Patients With Acute Transient Ischemic Attack: A Randomized Feasibility Trial

Dawn M BRAVATA; John CONCATO; George B RICHERSON; Mark GORMAN; Linda S WILLIAMS; Lawrence M BRASS; Joseph AGOSTINI; Vahid MOHSENIN; Francoise ROUX; H. Klar Yaggi; Terri FRIED; Noshene RANJBAR; Tanesh SADARANGANI; Vincent MCCLAIN; Frederick STRUVE; Lawrence ZYGMUNT; Herbert J KNIGHT; Albert LO

doi:10.1161/STROKEAHA.109.566745

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Auto-Titrating Continuous Positive Airway Pressure for Patients With Acute Transient Ischemic Attack: A Randomized Feasibility Trial

Journal article

Open access

Peer reviewed

Auto-Titrating Continuous Positive Airway Pressure for Patients With Acute Transient Ischemic Attack: A Randomized Feasibility Trial

Dawn M BRAVATA, John CONCATO, George B RICHERSON, Mark GORMAN, Linda S WILLIAMS, Lawrence M BRASS, Joseph AGOSTINI, Vahid MOHSENIN, Francoise ROUX, H. Klar Yaggi, …

Stroke (1970), Vol.41(7), pp.1464-1470

2010

DOI: 10.1161/STROKEAHA.109.566745

PMCID: PMC4567557

PMID: 20508184

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Abstract

Background and purpose: 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 2 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 after TIA. Control patients received polysomnography at baseline and at 90 days. Acceptable auto-CPAP adherence was defined as >or=4 hours per night for >or=75% of nights. Vascular events included recurrent TIA, stroke, hospitalization for congestive heart failure, myocardial infarction, or death. Results: We enrolled 70 acute TIA patients: 45 intervention and 25 control. 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.

Neurology

Biological and medical sciences

Vascular diseases and vascular malformations of the nervous system

Medical sciences

Blood. Blood coagulation. Reticuloendothelial system

Pharmacology. Drug treatments

Details

Title: Subtitle: Auto-Titrating Continuous Positive Airway Pressure for Patients With Acute Transient Ischemic Attack: A Randomized Feasibility Trial
Creators: Dawn M BRAVATA - Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, Ind, United States
John CONCATO - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
George B RICHERSON - Department of Neurology, Yale University School of Medicine, New Haven, Conn, United States
Mark GORMAN - Department of Neurology, University of Vermont College of Medicine, Burlington, Vt, United States
Linda S WILLIAMS - Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, Ind, United States
Lawrence M BRASS - Department of Neurology, Yale University School of Medicine, New Haven, Conn, United States
Joseph AGOSTINI - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
Vahid MOHSENIN - Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn, United States
Francoise ROUX - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
H. Klar Yaggi - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
Terri FRIED - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
Noshene RANJBAR - Research Service, VA Connecticut Healthcare System, West Haven, Conn, United States
Tanesh SADARANGANI - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
Vincent MCCLAIN - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
Frederick STRUVE - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
Lawrence ZYGMUNT - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn, United States
Herbert J KNIGHT - Hospital of St Raphael, New Haven, Conn., United States
Albert LO - Providence Veterans Administration Medical Center, Providence, RI, United States
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.41(7), pp.1464-1470
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
DOI: 10.1161/STROKEAHA.109.566745
PMID: 20508184
PMCID: PMC4567557
ISSN: 0039-2499
eISSN: 1524-4628
Language: English
Date published: 2010
Academic Unit: Neurology; Molecular Physiology and Biophysics; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984014022702771

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