Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke

Study objectives: A study was made of the role of continuous positive airway pressure (CPAP) treatment in the prevention of new vascular events following ischemic stroke or transient ischemic attack. Design: Prospective study. Patients and interventions: Demographic data, vascular risk factors, clinical manifestations associated to sleep apnea-hypopnea syndrome, and neurologic parameters were recorded in a group of patients presenting with acute ischemic stroke at least 2 months previously. A polygraphic study was carried out 2 months after the acute episode in all patients, with the prescription of CPAP. in the event of an apnea-hypopnea index (AHI) >= 20. Two groups were defined: patients who could tolerate CPAP (group 1), and patients who could not tolerate CPAP after 1 month of initial adaptation (group 2). Patients with an AHI < 20 were excluded. The incidence of new vascular events was evaluated throughout follow-up (18 months) in all patients, with an analysis of the role of CPAP in protecting the patients against such events. Results: Ninety-five patients were studied. Fifty-one patients (53.7%; mean age, 72.7 +/- 9.4 years [+/- SD]) presented with an AHI >= 20, and 15 patients (29.4%) tolerated CPAP. The incidence of new vascular events was greater in group 2 (6.7%) vs group 1 (36.1%; long-rank, p = 0.03). Intolerance of CPAP increased the probability, of a new vascular event fivefold (odds ratio, 5.09) adjusted for other vascular risk factors and neurologic indexes. Conclusions: We concluded that CPAP treatment during 18 months in patients with an AHI >= 20 afforded significant protection against new vascular events after ischemic stroke.