CPAP treatment for sleep apnea improves stroke outcomes: JAHA

Sleep apnea is a known risk factor for stroke, now a new study suggests that the use of -- CPAP (continuous positive airway pressure) mask -- is associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with sleep apnea.

Patients in the study, published in the Journal of the American Heart Association, typically used the CPAP mask -- "continuous positive airway pressure" -- to ease their nighttime breathing difficulties.

Obstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. Dawn M. Bravata, an investigator at the Regenstrief Institute in Indianapolis, Indiana, and colleagues evaluated whether CPAP for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes.

This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of OSA versus usual care over 1 year.

Primary outcomes were the National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. CPAP use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients.

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Key Findings:

• In intention‐to‐treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups.


• In as‐treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, −0.6±2.9; some, −0.9±1.4; good, −0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, −0.3±1.5; some, −0.4±1.0; good, −0.9±1.2; P=0.0237).


• In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0–1) versus 38% of controls (P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8).

The investigators found that, among stroke patients, "treatment of sleep apnea with CPAP therapy provides significant benefits, even greater than the benefits of tPA, the FDA-approved drug treatment for stroke," said study lead researcher Dr. Dawn Bravata.

"Although changes in neurological functioning and functional status were similar across the groups in the intention‐to‐treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA," concluded the authors.

For further reference follow the link: https://doi.org/10.1161/JAHA.118.008841