Auto-Titrating Continuous Positive Airway Pressure for Patients With Acute Transient Ischemic Attack A Randomized Feasibility Trial

被引：62

作者：

Bravata, Dawn M. ^{[1
,2
,4
]}

Concato, John ^{[5
,6
,9
]}

Fried, Terri ^{[5
,9
]}

Ranjbar, Noshene ^{[7
]}

Sadarangani, Tanesh ^{[5
]}

McClain, Vincent ^{[5
]}

Struve, Frederick ^{[5
]}

Zygmunt, Lawrence ^{[5
]}

Knight, Herbert J. ^{[14
]}

Lo, Albert ^{[11
,12
]}

Richerson, George B. ^{[8
,10
]}

Gorman, Mark ^{[13
]}

Williams, Linda S. ^{[3
,4
]}

Brass, Lawrence M. ^{[5
,10
]}

Agostini, Joseph ^{[5
,6
,9
]}

Mohsenin, Vahid ^{[9
]}

Roux, Francoise ^{[5
,9
]}

Yaggi, H. Klar ^{[5
,6
,9
]}

机构：

[1] Richard L Roudebush VA Med Ctr, Ctr Excellence Implementing Evidence Based Practi, HSR&D, Indianapolis, IN 46202 USA

[2] Indiana Univ, Sch Med, Dept Internal Med, Indianapolis, IN USA

[3] Indiana Univ, Sch Med, Dept Neurol, Indianapolis, IN 46202 USA

[4] Regenstrief Inst Hlth Care, Indianapolis, IN USA

[5] VA Connecticut Healthcare Syst, Clin Epidemiol Res Ctr, West Haven, CT USA

[6] VA Connecticut Healthcare Syst, Med Serv, West Haven, CT USA

[7] VA Connecticut Healthcare Syst, Res Serv, West Haven, CT USA

[8] VA Connecticut Healthcare Syst, Dept Neurol, West Haven, CT USA

[9] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA

[10] Yale Univ, Sch Med, Dept Neurol, New Haven, CT 06510 USA

[11] Providence Vet Adm Med Ctr, Providence, RI USA

[12] Brown Univ, Sch Med, Dept Neurol, Providence, RI 02912 USA

[13] Univ Vermont, Coll Med, Dept Neurol, Burlington, VT USA

[14] Hosp St Raphael, New Haven, CT 06511 USA

来源：

STROKE | 2010年 / 41卷 / 07期

基金：

美国国家卫生研究院;

关键词：

sleep disorders; TIA; treatment; OBSTRUCTIVE SLEEP-APNEA; SHORT-TERM PROGNOSIS; STROKE;

D O I：

10.1161/STROKEAHA.109.566745

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Background and Purpose-Transient ischemic attack (TIA) patients are at risk of recurrent vascular events. The primary objectives were to evaluate among TIA patients the prevalence of sleep apnea and among patients with sleep apnea auto-titrating continuous positive airway pressure (auto-CPAP) adherence. The secondary objective was to describe among TIA patients with sleep apnea the recurrent vascular event rate by auto-CPAP use category. Methods-All intervention patients received auto-CPAP for 2 nights, but only intervention patients with evidence of sleep apnea received auto-CPAP for the remainder of the 90-day period. Intervention patients received polysomnography at 90 days after TIA. Control patients received polysomnography at baseline and at 90 days. Acceptable auto-CPAP adherence was defined as >= 4 hours per night for >= 75% of nights. Vascular events included recurrent TIA, stroke, hospitalization for congestive heart failure, myocardial infarction, or death. Results-We enrolled 70 acute TIA patients: 45 intervention and 25 control. The majority of patients had sleep apnea: 57% at baseline and 59% at 90 days. Among the 30 intervention patients with airflow obstruction, 12 (40%) had acceptable auto-CPAP adherence, 18 (60%) had some use, and none had no use. Three intervention patients (12%) had recurrent events compared with 1 (2%; P=0.13) control patient. The vascular event rate was highest among sleep apnea patients with no CPAP use: none, 16%; some, 5%; acceptable adherence 0% (P=0.08). Conclusions-Sleep apnea is common among acute TIA patients. It appears feasible to provide auto-CPAP in the acute TIA period. Larger studies should evaluate whether a strategy of diagnosing and treating sleep apnea can reduce recurrent vascular events after TIA. (Stroke. 2010;41:1464-1470.)

引用

页码：1464 / 1470

页数：7

共 22 条

[1]

[Anonymous], 2006, COCHRANE DB SYST REV, DOI DOI 10.1002/14651858

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