Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial.
Obstructive sleep apnea (OSA) is common after stroke and predicts poor outcomes. Continuous positive airway pressure (CPAP) treats OSA but is generally poorly tolerated by stroke patients. We assessed whether nasal expiratory positive airway pressure (EPAP), an alternative to CPAP, may be an effective option after acute stroke.



We conducted a randomized, controlled, two-period crossover study in which each acute ischemic stroke patient received 1 night of EPAP and 1 night without EPAP while OSA was monitored with a validated device, the Watch-PAT 200. Linear repeated- measures analyses were conducted. Sample size calculations indicated that 18 subjects would be required to detect a 10-point or larger average reduction in the apnea-hypopnea index (AHI, the primary outcome), with use of EPAP, with power ≥ 80% and α = 0.05.



Among the 19 subjects who completed the protocol, nasal EPAP treatment was associated with a nonsignificant absolute difference in AHI of -5.73 events/h in the primary analysis (p = 0.183, 95% confidence interval -14.4, 2.97) and a nonsignificant absolute difference in AHI of -5.43 events/h in the subgroup of patients who used nasal EPAP for ≥ 3 h (p = 0.314, 95% confidence interval -16.6, 5.76).



This study suggests that EPAP is not an effective alternative to CPAP in acute stroke patients with OSA. Further work is needed to identify other more effective alternatives.



ClinicalTrials.gov, ID: NCT01703663.
University of Michigan Department of Neurology, Ann Arbor, Michigan.|University of Michigan Stroke Program, Ann Arbor, Michigan.
Natalie C
NC
Wheeler
Grand Valley State University Department of Public Health, Grand Rapids, Michigan.
Jeffrey J
JJ
Wing
University of Michigan Sleep Disorders Center, Ann Arbor, Michigan.
Louise M
LM
O'Brien
University of Michigan Stroke Program, Ann Arbor, Michigan.
Rebecca
R
Hughes
University of Michigan Stroke Program, Ann Arbor, Michigan.
Teresa
T
Jacobs
University of Michigan Department of Physical Medicine and Rehabilitation, Ann Arbor, Michigan.
Edward
E
Claflin
University of Michigan Department of Neurology, Ann Arbor, Michigan.|University of Michigan Sleep Disorders Center, Ann Arbor, Michigan.
Ronald D
RD
Chervin
University of Michigan Department of Neurology, Ann Arbor, Michigan.|University of Michigan Stroke Program, Ann Arbor, Michigan.
Devin L
DL
Brown
D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000628:therapy*; D020521:Stroke / Q000150:complications*
obstructive sleep apnea; positive pressure respiration; stroke