title: Effect of transnasal insufflation on sleep disordered breathing in acute stroke: a preliminary study.
abstract: OBJECTIVE
  Sleep disordered breathing (SDB) is frequent in acute stroke patients and is associated with early neurologic worsening and poor outcome. Although continuous positive airway pressure (CPAP) effectively treats SDB, compliance is low. The objective of the present study was to assess the tolerance and the efficacy of a continuous high-flow-rate air administered through an open nasal cannula (transnasal insufflation, TNI), a less-intrusive method, to treat SDB in acute stroke patients.
  
  
  METHODS
  Ten patients (age, 56.8 ± 10.7 years), with SDB ranging from moderate to severe (apnea-hypopnea index, AHI, >15/h of sleep) and on a standard sleep study at a mean of 4.8 ± 3.7 days after ischemic stroke (range, 1-15 days), were selected. The night after, they underwent a second sleep study while receiving TNI (18 L/min).
  
  
  RESULTS
  TNI was well tolerated by all patients. For the entire group, TNI decreased the AHI from 40.4 ± 25.7 to 30.8 ± 25.7/h (p = 0.001) and the oxygen desaturation index >3% from 40.7 ± 28.4 to 31 ± 22.5/h (p = 0.02). All participants except one showed a decrease in AHI. The percentage of slow-wave sleep significantly increased with TNI from 16.7 ± 8.2% to 22.3 ± 7.4% (p = 0.01). There was also a trend toward a reduction in markers of sleep disruption (number of awakenings, arousal index).
  
  
  CONCLUSIONS
  TNI improves SDB indices, and possibly sleep parameters, in stroke patients. Although these changes are modest, our findings suggest that TNI is a viable treatment alternative to CPAP in patients with SDB in the acute phase of ischemic stroke.
authors.affiliation: Center for Investigation and Research in Sleep, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland.
authors.forename: José
authors.initials: J
authors.lastname: Haba-Rubio
authors.forename: Daniela
authors.initials: D
authors.lastname: Andries
authors.forename: Vincianne
authors.initials: V
authors.lastname: Rey
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tafti
authors.forename: Raphael
authors.initials: R
authors.lastname: Heinzer
mesh_terms: D000328:Adult; D000368:Aged; D001143:Arousal / Q000502:physiology; D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply; D045422:Continuous Positive Airway Pressure; D006801:Humans; D007327:Insufflation / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D010349:Patient Compliance; D017060:Patient Satisfaction; D017286:Polysomnography; D012123:Pulmonary Ventilation / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*