Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack: a randomized feasibility trial.
OBJECTIVE
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.
Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, Ind 46202, USA. dbravata@iupui.edu
Dawn M
DM
Bravata
John
J
Concato
Terri
T
Fried
Noshene
N
Ranjbar
Tanesh
T
Sadarangani
Vincent
V
McClain
Frederick
F
Struve
Lawrence
L
Zygmunt
Herbert J
HJ
Knight
Albert
A
Lo
George B
GB
Richerson
Mark
M
Gorman
Linda S
LS
Williams
Lawrence M
LM
Brass
Joseph
J
Agostini
Vahid
V
Mohsenin
Francoise
F
Roux
H Klar
HK
Yaggi
D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*