Early diagnosis and treatment of obstructive sleep apnea after stroke

Davis, Arielle; Billings, Martha E.; Longstreth, W. T.; Khot, Sandeep P.

doi:10.1212/cpj.0b013e318296f274

Cited by 51 publications

(34 citation statements)

References 30 publications

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“…Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for ischemic and hemorrhagic stroke, 1,2 with prevalence after stroke or transient ischemic attack estimated to be over 70%. 3 Stroke patients with OSA compared to those without have worse functional outcome, longer hospitalization and rehabilitation stays, and higher mortality.…”

Section: Stroke Is the Leading Cause Of Long-term Disability In The Umentioning

confidence: 99%

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Khot

Davis

Crane

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea (OSA) predicts poor functional outcome after stroke and increases the risk for recurrent stroke. Less is known about continuous positive airway pressure (CPAP) treatment on stroke recovery. Methods: In a pilot randomized, double-blind, sham-controlled trial, adult stroke rehabilitation patients were assigned to auto-titrating or sham CPAP without diagnostic testing for OSA. Change in Functional Independence Measure (FIM), a measure of disability, was assessed between rehabilitation admission and discharge. Results: Over 18 months, 40 patients were enrolled and 10 withdrew from the study: 7 from active and 3 from sham CPAP (p > 0.10). For the remaining 30 patients, median duration of CPAP use was 14 days. Average CPAP use was 3.7 h/night, with at least 4 h nightly use among 15 patients. Adherence was not influenced by treatment assignment or stroke severity. In intention-to-treat analyses (n = 40), the median change in FIM favored active CPAP over sham but did not reach statistical significance (34 versus 26, p = 0.25), except for the cognitive component (6 versus 2.5, p = 0.04). The on-treatment analyses (n = 30) yielded similar results (total FIM: 32 versus 26, p = 0.11; cognitive FIM: 6 versus 2, p = 0.06). Conclusions: A sham-controlled CPAP trial among stroke rehabilitation patients was feasible in terms of recruitment, treatment without diagnostic testing and adequate blinding-though was limited by study retention and CPAP adherence. Despite these limitations, a trend towards a benefit of CPAP on recovery was evident. Tolerance and adherence must be improved before the full benefits of CPAP on recovery can be assessed in larger trials. I NTRO DUCTI O N Stroke is the leading cause of long-term disability in the UnitedStates, yet treatments that improve function after stroke are limited. Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for ischemic and hemorrhagic stroke, 1,2 with prevalence after stroke or transient ischemic attack estimated to be over 70%.3 Stroke patients with OSA compared to those without have worse functional outcome, longer hospitalization and rehabilitation stays, and higher mortality. [4][5][6][7][8][9] Despite the high risk of sleep apnea among patients with stroke and the implications for both stroke recovery and recurrent stroke, few stroke survivors undergo screening, testing, or treatment for OSA. 10 Barriers to evaluation and treatment involve OSA awareness among stroke survivors and clinical providers, access to in-laboratory polysomnography (PSG) testing, and the lack of consensus among stroke providers on the ideal timing for sleep testing.Treatment with continuous positive airway pressure (CPAP) among patients diagnosed with OSA is associated with improved functional and motor outcome after stroke, 11 but trials are limited by poor CPAP tolerance and adherence. 12,13 Compared to the general OSA population, patients with acute stroke are typically older with more functional disability and may have more diffic...

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Section: Stroke Is the Leading Cause Of Long-term Disability In The Umentioning

confidence: 99%

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Khot

Davis

Crane

et al. 2016

Journal of Clinical Sleep Medicine

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“…Direct spending on non-nursing home stroke care constitutes about 11% of the Medicare budget and close to 2% of overall national health expenditures (Ovbiagele et al, 2013). The long-term direct costs of nursing home care are even higher, and indirect costs from premature mortality and lost productivity for stroke victims are greater than all the costs combined (Demaerschalk, Hwang, & Leung, 2010). Taking all these costs into consideration, by 2030, the total annual costs of stroke are projected to increase to 240 billion dollars, an increase of 129% (Ovbiagele et al, 2013).…”

mentioning

confidence: 99%

Obstructive Sleep Apnea as an Independent Stroke Risk Factor

King

Cuellar

2016

Journal of Neuroscience Nursing

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OSA is highly prevalent in patients with stroke/TIA independently increasing stroke risk. CPAP studies revealed reduced stroke recurrence and improved recovery with feasible initiation in stroke units. Patients with stroke/TIA have less OSA-associated daytime sleepiness and obesity, making the usual screening tools insufficient and CPAP adherence challenging. Treating OSA decreases stroke prevalence and mortality. OSA initiatives empower neuroscience nurses to integrate this OSA evidence into clinical practice and improve stroke/TIA patient outcomes.

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“…Obstructive sleep apnea syndrome is a common disorder attributable to recurrent partial or complete collapse of the pharyngeal airway during sleep as a result of functional and/or anatomical factors. 40,120 The sequelae of OSA are thought to result from a sustained activation of the sympathetic nervous system leading to increased blood pressure and heart rate that, in combination with hemodynamic changes and the release of endothelin, predisposes to the development of coronary artery disease, congestive heart failure, and stroke. 120 There is a strong association between OSA and atrial fibrillation as well.…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

“…Documented benefits of CPAP therapy in OSA include reduction in systemic blood pressure; improvement in hemodynamic parameters, vascular factors including endothelin, inflammatory markers, and insulin resistance; and attenuation of potentially fatal arrhythmias. 40,120 Additionally, stroke patients with OSA receiving CPAP therapy may experience improvement in stroke-related impairment in functional and motor domains.…”

mentioning

confidence: 99%

Antithrombotic selection and risk factor management in ischemic stroke and transient ischemic attack

Katz

Flemming²

2014

FOC

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In addition to appropriate antithrombotic therapy, the identification and treatment of modifiable ischemic stroke risk factors can reduce the likelihood of recurrent stroke. Neurosurgeons should be knowledgeable of the specific risk factors and general recommendations for ischemic stroke, as they may play a significant role in the management options for patients with intracranial and extracranial atherosclerotic disease. The authors of this article review the indications for and selection of antithrombotics in patients with cerebral ischemia. In addition, the identification and secondary prevention of select risk factors are discussed.

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Early diagnosis and treatment of obstructive sleep apnea after stroke

Cited by 51 publications

References 30 publications

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Obstructive Sleep Apnea as an Independent Stroke Risk Factor

Antithrombotic selection and risk factor management in ischemic stroke and transient ischemic attack

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