Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack: A randomized feasibility trial

Dawn Bravata, John Concato, Terri Fried, Noshene Ranjbar, Tanesh Sadarangani, Vincent McClain, Frederick Struve, Lawrence Zygmunt, Herbert J. Knight, Albert Lo, George B. Richerson, Mark Gorman, Linda Williams, Lawrence M. Brass, Joseph Agostini, Vahid Mohsenin, Francoise Roux, H. Klar Yaggi

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1464-1470
Number of pages7
JournalStroke
Volume41
Issue number7
DOIs
StatePublished - Jul 2010

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Continuous Positive Airway Pressure
Transient Ischemic Attack
Sleep Apnea Syndromes
Blood Vessels
Polysomnography

Keywords

  • sleep disorders
  • TIA
  • treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack : A randomized feasibility trial. / Bravata, Dawn; Concato, John; Fried, Terri; Ranjbar, Noshene; Sadarangani, Tanesh; McClain, Vincent; Struve, Frederick; Zygmunt, Lawrence; Knight, Herbert J.; Lo, Albert; Richerson, George B.; Gorman, Mark; Williams, Linda; Brass, Lawrence M.; Agostini, Joseph; Mohsenin, Vahid; Roux, Francoise; Yaggi, H. Klar.

In: Stroke, Vol. 41, No. 7, 07.2010, p. 1464-1470.

Research output: Contribution to journalArticle

Bravata, D, Concato, J, Fried, T, Ranjbar, N, Sadarangani, T, McClain, V, Struve, F, Zygmunt, L, Knight, HJ, Lo, A, Richerson, GB, Gorman, M, Williams, L, Brass, LM, Agostini, J, Mohsenin, V, Roux, F & Yaggi, HK 2010, 'Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack: A randomized feasibility trial', Stroke, vol. 41, no. 7, pp. 1464-1470. https://doi.org/10.1161/STROKEAHA.109.566745
Bravata, Dawn ; Concato, John ; Fried, Terri ; Ranjbar, Noshene ; Sadarangani, Tanesh ; McClain, Vincent ; Struve, Frederick ; Zygmunt, Lawrence ; Knight, Herbert J. ; Lo, Albert ; Richerson, George B. ; Gorman, Mark ; Williams, Linda ; Brass, Lawrence M. ; Agostini, Joseph ; Mohsenin, Vahid ; Roux, Francoise ; Yaggi, H. Klar. / Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack : A randomized feasibility trial. In: Stroke. 2010 ; Vol. 41, No. 7. pp. 1464-1470.
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abstract = "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.",
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T1 - Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack

T2 - A randomized feasibility trial

AU - Bravata, Dawn

AU - Concato, John

AU - Fried, Terri

AU - Ranjbar, Noshene

AU - Sadarangani, Tanesh

AU - McClain, Vincent

AU - Struve, Frederick

AU - Zygmunt, Lawrence

AU - Knight, Herbert J.

AU - Lo, Albert

AU - Richerson, George B.

AU - Gorman, Mark

AU - Williams, Linda

AU - Brass, Lawrence M.

AU - Agostini, Joseph

AU - Mohsenin, Vahid

AU - Roux, Francoise

AU - Yaggi, H. Klar

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N2 - 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.

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