title: Continuous positive airway pressure ventilation for acute ischemic stroke: a randomized feasibility study.
abstract: OBJECTIVE
  Sleep-related breathing disorders occur frequently after stroke. We assessed the feasibility of continuous positive airway pressure (CPAP) treatment initiated in the first night after stroke.
  
  
  METHODS
  In this open-label, parallel-group trial, 50 patients were randomly assigned to the CPAP therapy or to the control group. All patients underwent polysomnography in the fourth night. Intervention patients received CPAP therapy for 3 nights starting the first night after stroke onset and for an additional 4 nights when polysomnography revealed an apnea-hypopnea index >10/hour. The primary end point was feasibility defined as apnea-hypopnea index reduction under CPAP treatment, nursing workload, and CPAP adherence.
  
  
  RESULTS
  The apnea-hypopnea index under CPAP treatment was significantly reduced (32.2±25.3-9.8±6.6, P=0.0001). Nursing workload did not significantly differ between the CPAP (n=25) and the control group (n=25; P=0.741). Ten patients (40.0%) had excellent CPAP use, 14 patients (56.0%) had some use, and 1 patient (4.0%) had no use. There was a trend toward greater National Institutes of Health Stroke Scale score improvement until Day 8 in patients on CPAP (2.00 versus 1.40, P=0.092) and a significantly greater National Institutes of Health Stroke Scale score improvement in patients with excellent CPAP use when compared with control patients (2.30 versus 1.40, P=0.022).
  
  
  CONCLUSIONS
  CPAP therapy initiated in the first night after stroke seems to be feasible and was not associated with neurological deterioration.  Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT00151177.
authors.affiliation: Department of Neurology, University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany. minnerup@uni-muenster.de
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
authors.forename: Martin Andreas
authors.initials: MA
authors.lastname: Ritter
authors.forename: Heike
authors.initials: H
authors.lastname: Wersching
authors.forename: André
authors.initials: A
authors.lastname: Kemmling
authors.forename: Angelika
authors.initials: A
authors.lastname: Okegwo
authors.forename: Antje
authors.initials: A
authors.lastname: Schmidt
authors.forename: Matthias
authors.initials: M
authors.lastname: Schilling
authors.forename: E Bernd
authors.initials: EB
authors.lastname: Ringelstein
authors.forename: Wolf Rüdiger
authors.initials: WR
authors.lastname: Schäbitz
authors.forename: Peter
authors.initials: P
authors.lastname: Young
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000503:physiopathology / Q000628:therapy*; D045422:Continuous Positive Airway Pressure; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000628:therapy; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors