Chest
Volume 128, Issue 4, October 2005, Pages 2123-2129
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Clinical Investigations
Continuous Positive Airway Pressure Treatment in Sleep Apnea Prevents New Vascular Events After Ischemic Stroke

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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.

Section snippets

Patients

The present study selected all patients with ischemic stroke or TIA admitted to our center during the year 2002, and who had passed the acute phase of the neurologic event and were in a stable phase. Patients previously treated with CPAP were excluded. Patients with a new VE prior to conduction of the sleep diagnostic study were temporarily excluded until 2 months after the last cerebral vascular event. The study protocol was approved by the local ethics committee, and all patients gave

Results

Of 139 consecutive patients admitted to our center with a diagnosis of ischemic stroke or TIA, 110 patients survived for at least 2 months after the ischemic cerebrovascular episode. Of these patients, two who had received CPAP treatment previously were excluded. Twelve patients either failed to give consent or did not report to the sleep study, and 3 patients could not be contacted following the acute episode. The diagnostic polygraphic study was carried out after 64 ± 11 days in 95 patients,

Discussion

According to our results, CPAP treatment protected against the appearance of a new VE after ischemic stroke or TIA in patients with an AHI ≥ 20 following stabilization of the neurologic process, without inducing changes in the neurologic recovery parameters, although tolerance of the treatment was low. Some studies have analyzed the course of patients with ischemic stroke in relation to the incidence of SAHS after stabilization of the ischemic event. Good et al31 reported poorer neurologic

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