Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial.
Obstructive sleep apnea (OSA) predicts poor functional outcome after stroke and increases the risk for recurrent stroke. Less is known about continuous positive airway pressure (CPAP) treatment on stroke recovery.



In a pilot randomized, double-blind, sham-controlled trial, adult stroke rehabilitation patients were assigned to auto-titrating or sham CPAP without diagnostic testing for OSA. Change in Functional Independence Measure (FIM), a measure of disability, was assessed between rehabilitation admission and discharge.



Over 18 months, 40 patients were enrolled and 10 withdrew from the study: 7 from active and 3 from sham CPAP (p > 0.10). For the remaining 30 patients, median duration of CPAP use was 14 days. Average CPAP use was 3.7 h/night, with at least 4 h nightly use among 15 patients. Adherence was not influenced by treatment assignment or stroke severity. In intention-to-treat analyses (n = 40), the median change in FIM favored active CPAP over sham but did not reach statistical significance (34 versus 26, p = 0.25), except for the cognitive component (6 versus 2.5, p = 0.04). The on-treatment analyses (n = 30) yielded similar results (total FIM: 32 versus 26, p = 0.11; cognitive FIM: 6 versus 2, p = 0.06).



A sham-controlled CPAP trial among stroke rehabilitation patients was feasible in terms of recruitment, treatment without diagnostic testing and adequate blinding-though was limited by study retention and CPAP adherence. Despite these limitations, a trend towards a benefit of CPAP on recovery was evident. Tolerance and adherence must be improved before the full benefits of CPAP on recovery can be assessed in larger trials.
Department of Neurology, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Sandeep P
SP
Khot
Department of Neurology, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Arielle P
AP
Davis
Department of Physical Medicine and Rehabilitation, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Deborah A
DA
Crane
Department of Neurology, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Patricia M
PM
Tanzi
Department of Physical Medicine and Rehabilitation, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Denise Li
DL
Lue
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
Edward S
ES
Claflin
Department of Neurology, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Kyra J
KJ
Becker
Department of Neurology, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
W T
WT
Longstreth
Department of Neurology, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Nathaniel F
NF
Watson
Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA.
Martha E
ME
Billings
D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
continuous positive airway pressure; obstructive sleep apnea; rehabilitation; stroke