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

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

doi:10.5665/SLEEP.1254

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

Journal article

Open access

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

Dawn M Bravata, John Concato, Terri Fried, Noshene Ranjbar, Tanesh Sadarangani, Vincent McClain, Frederick Struve, Lawrence Zygmunt, Herbert J Knight, Albert Lo, …

Sleep (New York, N.Y.), Vol.34(9), pp.1271-1277

09/01/2011

DOI: 10.5665/SLEEP.1254

PMCID: PMC3157669

PMID: 21886365

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Abstract

Background: New approaches are needed to treat patients with stroke. Among acute ischemic stroke patients, our primary objectives were to describe the prevalence of sleep apnea and demonstrate the feasibility of providing auto-titrating continuous positive airway pressure (auto-CPAP). A secondary objective was to examine the effect of auto-CPAP on stroke severity. Methods: Stroke patients randomized to the intervention group received 2 nights of auto-CPAP, but only those with evidence of sleep apnea received auto-CPAP for the remainder of the 30-day period. Intervention patients received polysomnography 30 days post-stroke. Control patients received polysomnography at baseline and after 30 days. Acceptable auto-CPAP adherence was defined as ≥ 4 h/night for ≥ 75% nights. Change in stroke severity was assessed comparing the NIH Stroke Scale (NIHSS) at baseline versus at 30 days. Results: The 2 groups (intervention N = 31, control N = 24) had similar baseline stroke severity (both median NIHSS, 3.0). Among patients with complete polysomnography data, the majority had sleep apnea: baseline, 13/15 (86.7%) control patients; 30 days, 24/35 (68.6%) control and intervention patients. Intervention patients had greater improvements in NIHSS (-3.0) than control patients (-1.0); P = 0.03. Among patients with sleep apnea, greater improvement was observed with increasing auto-CPAP use: -1.0 for control patients not using auto-CPAP; -2.5 for intervention patients with some auto-CPAP use; and -3.0 for intervention patients with acceptable auto-CPAP adherence. Conclusions: 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.

Sleep Apnea

Acute ischemic stroke

Evaluation of CPAP for Patients with Acute Ischemic Stroke

continuous positive airway pressure

Details

Title: Subtitle: Continuous Positive Airway Pressure: Evaluation of a Novel Therapy for Patients with Acute Ischemic Stroke
Creators: Dawn M Bravata - Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN
John Concato - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Terri Fried - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Noshene Ranjbar - Research Service, VA Connecticut Healthcare System, West Haven, CT
Tanesh Sadarangani - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Vincent McClain - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Frederick Struve - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Lawrence Zygmunt - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Herbert J Knight - Hospital of St. Raphael, New Haven, CT
Albert Lo - Providence Veterans Administration Hospital, Providence, RI
George B Richerson - Department of Neurology, University of Iowa, Iowa City, IA
Mark Gorman - Department of Neurology, University of Vermont College of Medicine, Burlington, VT
Linda S Williams - Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN
Lawrence M Brass - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Joseph Agostini - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Vahid Mohsenin - Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
Francoise Roux - Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
H. Klar Yaggi - Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
Resource Type: Journal article
Publication Details: Sleep (New York, N.Y.), Vol.34(9), pp.1271-1277
Publisher: Associated Professional Sleep Societies, LLC
DOI: 10.5665/SLEEP.1254
PMID: 21886365
PMCID: PMC3157669
ISSN: 0161-8105
eISSN: 1550-9109
Language: English
Date published: 09/01/2011
Academic Unit: Neurology; Molecular Physiology and Biophysics; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984013201602771

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