Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease

Dawn Bravata, Jason Sico, Carlos A. Vaz Fragoso, Edward Miech, Marianne Matthias, Rachel Lampert, Linda Williams, John Concato, Cristina Ivan, James Fleck, Lauren Tobias, Charles Austin, Jared Ferguson, Radu Radulescu, Lynne Iannone, Susan Ofner, Stanley Taylor, Li Qin, Christine Won, H. Klar YaggiRichard L. Roudebush

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background—Obstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes. Methods and Results—This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment ofOSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention-to-treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as-treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, ˗0.6±2.9; some, ˗0.9±1.4; good, ˗0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, ˗0.3±1.5; some, ˗0.4±1.0; good, ˗0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0-1) versus 38% of controls (P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8). Conclusions—Although changes in neurological functioning and functional status were similar across the groups in the intentionto-treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA.

Original languageEnglish (US)
Article numbere008841
JournalJournal of the American Heart Association
Volume7
Issue number16
DOIs
StatePublished - Aug 1 2018

Fingerprint

Cerebrovascular Disorders
Sleep Apnea Syndromes
Acute Disease
Stroke
Continuous Positive Airway Pressure
Transient Ischemic Attack
National Institutes of Health (U.S.)
Numbers Needed To Treat
Intention to Treat Analysis
Randomized Controlled Trials

Keywords

  • Acute ischemic stroke
  • Sleep apnea
  • Transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease. / Bravata, Dawn; Sico, Jason; Vaz Fragoso, Carlos A.; Miech, Edward; Matthias, Marianne; Lampert, Rachel; Williams, Linda; Concato, John; Ivan, Cristina; Fleck, James; Tobias, Lauren; Austin, Charles; Ferguson, Jared; Radulescu, Radu; Iannone, Lynne; Ofner, Susan; Taylor, Stanley; Qin, Li; Won, Christine; Klar Yaggi, H.; Roudebush, Richard L.

In: Journal of the American Heart Association, Vol. 7, No. 16, e008841, 01.08.2018.

Research output: Contribution to journalArticle

Bravata, D, Sico, J, Vaz Fragoso, CA, Miech, E, Matthias, M, Lampert, R, Williams, L, Concato, J, Ivan, C, Fleck, J, Tobias, L, Austin, C, Ferguson, J, Radulescu, R, Iannone, L, Ofner, S, Taylor, S, Qin, L, Won, C, Klar Yaggi, H & Roudebush, RL 2018, 'Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease', Journal of the American Heart Association, vol. 7, no. 16, e008841. https://doi.org/10.1161/JAHA.118.008841
Bravata, Dawn ; Sico, Jason ; Vaz Fragoso, Carlos A. ; Miech, Edward ; Matthias, Marianne ; Lampert, Rachel ; Williams, Linda ; Concato, John ; Ivan, Cristina ; Fleck, James ; Tobias, Lauren ; Austin, Charles ; Ferguson, Jared ; Radulescu, Radu ; Iannone, Lynne ; Ofner, Susan ; Taylor, Stanley ; Qin, Li ; Won, Christine ; Klar Yaggi, H. ; Roudebush, Richard L. / Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 16.
@article{13c56ff0379f49c293423682ca650929,
title = "Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease",
abstract = "Background—Obstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes. Methods and Results—This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment ofOSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69{\%}; standard, 74{\%}; and enhanced, 80{\%}. Continuous positive airway pressure use occurred on average 50{\%} of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention-to-treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as-treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, ˗0.6±2.9; some, ˗0.9±1.4; good, ˗0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, ˗0.3±1.5; some, ˗0.4±1.0; good, ˗0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59{\%} of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0-1) versus 38{\%} of controls (P=0.038); absolute risk reduction was 21{\%} (number needed to treat, 4.8). Conclusions—Although changes in neurological functioning and functional status were similar across the groups in the intentionto-treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA.",
keywords = "Acute ischemic stroke, Sleep apnea, Transient ischemic attack",
author = "Dawn Bravata and Jason Sico and {Vaz Fragoso}, {Carlos A.} and Edward Miech and Marianne Matthias and Rachel Lampert and Linda Williams and John Concato and Cristina Ivan and James Fleck and Lauren Tobias and Charles Austin and Jared Ferguson and Radu Radulescu and Lynne Iannone and Susan Ofner and Stanley Taylor and Li Qin and Christine Won and {Klar Yaggi}, H. and Roudebush, {Richard L.}",
year = "2018",
month = "8",
day = "1",
doi = "10.1161/JAHA.118.008841",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "16",

}

TY - JOUR

T1 - Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease

AU - Bravata, Dawn

AU - Sico, Jason

AU - Vaz Fragoso, Carlos A.

AU - Miech, Edward

AU - Matthias, Marianne

AU - Lampert, Rachel

AU - Williams, Linda

AU - Concato, John

AU - Ivan, Cristina

AU - Fleck, James

AU - Tobias, Lauren

AU - Austin, Charles

AU - Ferguson, Jared

AU - Radulescu, Radu

AU - Iannone, Lynne

AU - Ofner, Susan

AU - Taylor, Stanley

AU - Qin, Li

AU - Won, Christine

AU - Klar Yaggi, H.

AU - Roudebush, Richard L.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background—Obstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes. Methods and Results—This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment ofOSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention-to-treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as-treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, ˗0.6±2.9; some, ˗0.9±1.4; good, ˗0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, ˗0.3±1.5; some, ˗0.4±1.0; good, ˗0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0-1) versus 38% of controls (P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8). Conclusions—Although changes in neurological functioning and functional status were similar across the groups in the intentionto-treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA.

AB - Background—Obstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes. Methods and Results—This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment ofOSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention-to-treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as-treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, ˗0.6±2.9; some, ˗0.9±1.4; good, ˗0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, ˗0.3±1.5; some, ˗0.4±1.0; good, ˗0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0-1) versus 38% of controls (P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8). Conclusions—Although changes in neurological functioning and functional status were similar across the groups in the intentionto-treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA.

KW - Acute ischemic stroke

KW - Sleep apnea

KW - Transient ischemic attack

UR - http://www.scopus.com/inward/record.url?scp=85052401984&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052401984&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.008841

DO - 10.1161/JAHA.118.008841

M3 - Article

C2 - 30369321

AN - SCOPUS:85052401984

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 16

M1 - e008841

ER -