title: Continuous positive airway pressure: evaluation of a novel therapy for patients with acute ischemic stroke.
abstract: BACKGROUND
  New approaches are needed to treat patients with stroke. Among acute ischemic stroke patients, our primary objectives were to describe the prevalence of sleep apnea and demonstrate the feasibility of providing auto-titrating continuous positive airway pressure (auto-CPAP). A secondary objective was to examine the effect of auto-CPAP on stroke severity.
  
  
  METHODS
  Stroke patients randomized to the intervention group received 2 nights of auto-CPAP, but only those with evidence of sleep apnea received auto-CPAP for the remainder of the 30-day period. Intervention patients received polysomnography 30 days post-stroke. Control patients received polysomnography at baseline and after 30 days. Acceptable auto-CPAP adherence was defined as ≥ 4 h/night for ≥ 75% nights. Change in stroke severity was assessed comparing the NIH Stroke Scale (NIHSS) at baseline versus at 30 days.
  
  
  RESULTS
  The 2 groups (intervention N = 31, control N = 24) had similar baseline stroke severity (both median NIHSS, 3.0). Among patients with complete polysomnography data, the majority had sleep apnea: baseline, 13/15 (86.7%) control patients; 30 days, 24/35 (68.6%) control and intervention patients. Intervention patients had greater improvements in NIHSS (-3.0) than control patients (-1.0); P = 0.03. Among patients with sleep apnea, greater improvement was observed with increasing auto-CPAP use: -1.0 for control patients not using auto-CPAP; -2.5 for intervention patients with some auto-CPAP use; and -3.0 for intervention patients with acceptable auto-CPAP adherence.
  
  
  CONCLUSIONS
  The majority of acute stroke patients had sleep apnea. Auto-CPAP was well tolerated, appears to improve neurological recovery from stroke, and may represent a new therapeutic approach for selected patients with acute cerebral infarction.
authors: Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA. dbravata@iupui.edu
authors: Dawn M
authors: DM
authors: Bravata
authors: John
authors: J
authors: Concato
authors: Terri
authors: T
authors: Fried
authors: Noshene
authors: N
authors: Ranjbar
authors: Tanesh
authors: T
authors: Sadarangani
authors: Vincent
authors: V
authors: McClain
authors: Frederick
authors: F
authors: Struve
authors: Lawrence
authors: L
authors: Zygmunt
authors: Herbert J
authors: HJ
authors: Knight
authors: Albert
authors: A
authors: Lo
authors: George B
authors: GB
authors: Richerson
authors: Mark
authors: M
authors: Gorman
authors: Linda S
authors: LS
authors: Williams
authors: Lawrence M
authors: LM
authors: Brass
authors: Joseph
authors: J
authors: Agostini
authors: Vahid
authors: V
authors: Mohsenin
authors: Francoise
authors: F
authors: Roux
authors: H Klar
authors: HK
authors: Yaggi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D020127:Recovery of Function; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome