Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial

Parra, Olga; Sánchez‐Armengol, Ángeles; Bonnin, Mar Colorado; Arboix, Adrià; Campos‐Rodríguez, Francisco; Pérez-Ronchel, José; Durán-Cantolla, Joaquín; Torre, G. De La; Marcos, Jaime; Peña, Mónica de la; Jiménez, Maria Carmen; Masa, Fernando; Casado, I.; Alonso, M.L.; Macarrón, José L.

doi:10.1183/09031936.00034410

Cited by 217 publications

(170 citation statements)

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“…They found no significant impact of CPAP treatment on all-cause mortality after two years of follow-up (HR, 0.62; 95% CI, 0.11-3.46). 29 The two other intervention studies are cohort studies with follow-up between five and seven years. 28,24 The study by Martínez-García et al concludes that patients with an AHI ≥ 20 and adequate CPAP compliance had hazard ratios that were not different from patients with an AHI < 20 in terms of both fatal and nonfatal cardiovascular events.…”

Section: How Cpap Affects Stroke and Tia Outcome In Patients With Sdbmentioning

confidence: 99%

“…24,28,29 The definition of SDB varied from an AHI of 10 events/hour in combination with excessive daytime sleepiness to 20 events/hour. Compliance rates varied from 11% 28 to 72%, 29 with a mean of 37%. Parra et al contributed with the only randomized controlled trial identified on this topic.…”

Section: How Cpap Affects Stroke and Tia Outcome In Patients With Sdbmentioning

confidence: 99%

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The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review

Birkbak

Clark

Rod

2014

Journal of Clinical Sleep Medicine

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Study Objectives: The primary objective was to systematically review the literature on how sleep disordered breathing (SDB) affects recurrence and death among stroke or transient ischemic attack (TIA) patients. A secondary objective was to evaluate how treatment of SDB with continuous positive airway pressure (CPAP) affects the risk of recurrence and death in these patients. Methods: Adults (18+) with a stroke or TIA diagnosis were eligible for inclusion. Case groups consisted of patients with a sleep disorder. The outcomes of interest were all-cause mortality, recurrent vascular events, and case fatality. Results: Ten articles covering 1,203 stroke and TIA patients were included in the review. The results generally support a dose-response relationship between severity of SDB and risk of recurrent events and all-cause mortality in stroke and TIA patients. Three small-scale articles with substantial risk of bias evaluated the effects of CPAP therapy, and the results are inconclusive. Data on case fatality is too sparse to be conclusive. Conclusions: Existing studies provide suffi cient data to establish obstructive SDB as a negative predictor of all-cause mortality and recurrent vascular events following stroke or TIA. The ability of CPAP treatment to lower the risk of serious adverse outcomes after stroke remains controversial because of substantial risk of bias identifi ed in most of the eligible studies addressing this relation. Additional studies are needed. S leep disordered breathing (SDB) is a term used to describe nocturnal breathing and ventilatory problems. SDB includes obstructive sleep apnea, which is defi ned as partial or complete closure of the upper airways and central sleep apnea, which describes apneic events due to lack of respiratory effort.1 The severity of SDB is measured by the number of apneas and hypopneas per hours of sleep, the apneahypopnea index (AHI).SDB has been associated with 2-3 times higher risk of incident stroke in several large well-designed prospective studies.2-5 Moreover, a recent meta-analysis concludes that SDB with an AHI > 5 events/hour is seen in 72% and with AHI > 20 events/hour in 38% of all stroke or transient ischemic attack (TIA) patients. 6 The highest prevalence of SDB is seen among male patients, patients with recurrent strokes, and those with stroke of unknown etiology. The underlying mechanisms explaining a high prevalence of SDB among stroke and TIA patients remain to be established, but the hypothesized mechanisms behind a deleterious effect of SDB on stroke incidence and prognosis include hypertension, endothelial damage, cardiac arrhythmias, variability in cerebral blood fl ow, and oxygen desaturation . 7-9Two previous reviews have found that SDB in stroke patients leads to poorer outcomes and increased risk of recurrent strok e. 10,11 Another review is inconclusive about the benefi ts from treatment of SDB after stroke. 12 The relationship between stroke and SDB is being increasingly discussed in the scientifi c 12,13 and we aimed to systematically eval...

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Section: How Cpap Affects Stroke and Tia Outcome In Patients With Sdbmentioning

confidence: 99%

Section: How Cpap Affects Stroke and Tia Outcome In Patients With Sdbmentioning

confidence: 99%

The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review

Birkbak

Clark

Rod

2014

Journal of Clinical Sleep Medicine

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“…Several randomized controlled studies have evaluated the use of CPAP among patients with acute ischemic stroke or TIA, but they have been limited by short follow‐up or small sample size 1, 3, 4, 5. The largest of the randomized trials observed (N=126) patients with acute stroke with sleep apnea over a 2‐year period 6. Patients were randomly assigned to receive either fixed‐pressure CPAP or usual care.…”

Section: Introductionmentioning

confidence: 99%

Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

Bravata

Sico

Fragoso

et al. 2018

JAHA

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BackgroundObstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes.Methods and ResultsThis randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of OSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention‐to‐treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as‐treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, −0.6±2.9; some, −0.9±1.4; good, −0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, −0.3±1.5; some, −0.4±1.0; good, −0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0–1) versus 38% of controls (P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8).ConclusionsAlthough changes in neurological functioning and functional status were similar across the groups in the intention‐to‐treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01446913.

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“…However, randomized controlled trials were not strong enough to show this effect. Some studies found that CPAP improved 1 or more neurologic function outcomes, sleepiness, or mood, [13][14][15]47 whereas the others found no benefit of CPAP treatment in these areas. [113][114][115] However, the negative studies had small sample sizes and patients had low CPAP compliance, which may have affected the results.…”

Section: Early Treatment Of Obstructive Sleep Apnea In Stroke Rehabilmentioning

confidence: 99%

“…11 There is growing evidence that treatment of coexisting OSA with continuous positive airway pressure (CPAP) or mandibular advancement devices can successfully treat OSA, resulting in improved rehabilitation outcomes and improved health-related quality of life. [12][13][14][15] …”

Section: Introductionmentioning

confidence: 99%

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

Jafari

2017

Sleep Medicine Clinics

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Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial

Cited by 217 publications

References 53 publications

The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review

The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review

Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

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