Continuous Positive Airway Pressure: Evaluation of a Novel Therapy for Patients with Acute lschemic Stroke

被引：123

作者：

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

Concato, John ^{[5
,6
,7
]}

Fried, Terri ^{[5
,7
]}

Ranjbar, Noshene ^{[9
]}

Sadarangani, Tanesh ^{[5
]}

McClain, Vincent ^{[5
]}

Struve, Frederick ^{[5
]}

Zygmunt, Lawrence ^{[5
]}

Knight, Herbert J. ^{[13
]}

Lo, Albert ^{[10
,11
]}

Richerson, George B. ^{[15
]}

Gorman, Mark ^{[12
]}

Williams, Linda S. ^{[1
,3
,4
]}

Brass, Lawrence M. ^{[5
,8
,14
]}

Agostini, Joseph ^{[5
,6
,7
]}

Mohsenin, Vahid ^{[7
]}

Roux, Francoise ^{[7
]}

Yaggi, H. Klar ^{[5
,6
,7
]}

机构：

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

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

[3] Indiana Univ Sch Med, Dept Neurol, Indianapolis, IN 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] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA

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

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

[10] Providence Vet Adm Hosp, Providence, RI USA

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

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

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

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

[15] Univ Iowa, Dept Neurol, Iowa City, IA 52242 USA

来源：

SLEEP | 2011年 / 34卷 / 09期

关键词：

Acute ischemic stroke; sleep apnea; continuous positive airway pressure; OBSTRUCTIVE SLEEP-APNEA; PREVALENCE; DIAGNOSIS; HYPOPNEA;

D O I：

10.5665/SLEEP.1254

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: New approaches are needed to treat patients with stroke. Among acute ischemic stroke patients, our primary objectives were to describe the prevalence of sleep apnea and demonstrate the feasibility of providing auto-titrating continuous positive airway pressure (auto-CPAP). A secondary objective was to examine the effect of auto-CPAP on stroke severity. Methods: Stroke patients randomized to the intervention group received 2 nights of auto-CPAP, but only those with evidence of sleep apnea received auto-CPAP for the remainder of the 30-day period. Intervention patients received polysomnography 30 days post-stroke. Control patients received polysomnography at baseline and after 30 days. Acceptable auto-CPAP adherence was defined as >= 4 h/night for >= 75% nights. Change in stroke severity was assessed comparing the NIH Stroke Scale (NIHSS) at baseline versus at 30 days. Results: The 2 groups (intervention N = 31, control N = 24) had similar baseline stroke severity (both median NIHSS, 3.0). Among patients with complete polysomnography data, the majority had sleep apnea: baseline, 13/15(86.7%) control patients; 30 days, 24/35(68.6%) control and intervention patients. Intervention patients had greater improvements in NIHSS (-3.0) than control patients (-1.0); P = 0.03. Among patients with sleep apnea, greater improvement was observed with increasing auto-CPAP use: -1.0 for control patients not using auto-CPAP; -2.5 for intervention patients with some auto-CPAP use; and -3.0 for intervention patients with acceptable auto-CPAP adherence. Conclusions: The majority of acute stroke patients had sleep apnea. Auto-CPAP was well tolerated, appears to improve neurological recovery from stroke, and may represent a new therapeutic approach for selected patients with acute cerebral infarction.

引用

页码：1271 / 1277

页数：7

共 36 条

[1]

Left ventricular function in patients with obstructive sleep apnoea syndrome before and after treatment with nasal continuous positive airway pressure [J].