Continuous Positive Airway Pressure Treatment Reduces Mortality in Patients with Ischemic Stroke and Obstructive Sleep Apnea

Abstract

Our results suggest that long-term CPAP treatment in moderate to severe OSA and ischemic stroke is associated with a reduction in excess risk of mortality.

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

“…1,7,9,10,36,37,[68][69][70][71][72] In addition, severe OSA not only increases the risk of stroke recurrence but also increases the incidence of fatal and nonfatal cardiovascular events as well as sudden death during sleep. 44,[73][74][75] The higher blood pressure and its swing during episodes of upper airways obstruction lead to worse outcome following stroke. 76 Sleep apnea probably promotes this functional impairment through intermittent nocturnal hypoxia, reduced cerebral perfusion, and fragmented sleep.…”

“…76 Treatment of coexisting OSA decreases both nocturnal and diurnal blood pressure 56,110 and as a result reduces risk of stroke recurrence, 111 reduces mortality, 74 and improves quality of life. 56, 69 Because SDB improves after the acute phase of stroke, auto-CPAP systems may be preferable.…”

“…There are several reasons for poor compliance, including spontaneous improvement of SDB, lack of excessive daytime sleepiness in some patients, and motor (facial and bulbar palsy) and cognitive (confusional states, dementia, aphasia) deficits. Compliance has been reported to be as low as 25% to 50% in the acute 39,53,113,116,117 or subacute 69,74,114 stroke phase, whereas other groups reported rates as high as 70% in the rehabilitation setting. 56 This finding indicates the importance of CPAP acclimation by skilled respiratory therapists.…”

Treatment of Risk Factors to Prevent Stroke

“…Although CPAP compliance was 70% in the rehabilitation setting, in the acute phase the rate remains at approximately 25% [101]. In another study, stroke patients with SDB who did not tolerate CPAP had higher 5-year mortality than those who tolerated CPAP [102]. Beyond hypertension and obesity, the link between SDB and stroke may include intermittent hypoxemia of OSA and pulmonary vasoconstriction, increased pulmonary artery, pressure, diastolic cardiac dysfunction, and atrial fibrillation.…”

New and Unconventional Treatments for Obstructive Sleep Apnea

“…sleepiness [3], and snoring, but a reduction in hypertension [4], car accidents [5,6] and mortality [7] is also seen in patients compliant with therapy. In addition, CPAP has shown itself to be a cost effective treatment option compared to lifestyle measures [8] There is a wide range of CPAP compliance rates reported in the literature, varying by study design and definitions of compliance, with values ranging from 46 % to 85 % [9,10].…”