title: Positional therapy in ischemic stroke patients with obstructive sleep apnea.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is common in stroke patients and is associated with poor functional outcome. The effects of positional therapy in ischemic stroke patients with OSA have not been investigated. We tested the hypothesis that ischemic stroke patients have less severe OSA during positional therapy that promotes nonsupine positioning.
  
  
  METHODS
  We conducted a randomized, controlled, cross-over study. Sleep apnea screening studies were performed on two consecutive nights, using a portable respiratory monitoring system, on 18 subjects within the first 14days of ischemic stroke. An apnea-hypopnea index (AHI) ⩾5 established the diagnosis of OSA. Subjects were randomized to positional therapy that included the use of a therapeutic pillow on either the first or second night. On the control night, subjects used the hospital pillow and were positioned ad lib. Treatment effect on AHI was estimated using a repeated measures model.
  
  
  RESULTS
  All ischemic stroke subjects studied had OSA. The predominantly male group had a median age of 58years, BMI of 29kg/m(2), NIH Stroke Scale score of 3, and a median AHI on the nontherapeutic night of 39 (interquartile range: 21-54). Positional therapy reduced the amount of supine positioning by 36% (95% CI: 18-55% (P<0.001)). The AHI was reduced by 19.5% (95% CI: 4.9-31.9% (P=0.011)), when using positional therapy compared to sleeping ad lib.
  
  
  CONCLUSIONS
  Positional therapy to avoid supine positioning modestly reduces sleep apnea severity after ischemic stroke, and may therefore improve outcomes.
authors.affiliation: Stroke Program, The Cardiovascular Center, Stroke Program, 1500 East Medical Center Drive, SPC#5855, Ann Arbor, MI 48109-5855, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Svatikova
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Wing
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sanchez
authors.forename: Erin M
authors.initials: EM
authors.lastname: Migda
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000628:therapy*; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome