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 At least 25 million adults in the U.S. have obstructive sleep apnea,
which causes their airway to close, briefly halting breathing, for a
few seconds multiple times during sleep. The condition has been
linked with increased risk for heart attack, hypertension, sudden
death, stroke and faster progression of cardiovascular disease.
Sleep apnea sufferers can use CPAP machines to keep their airway
open during sleep.
In the study, researchers found that stroke patients diagnosed with
sleep apnea saw greater improvements in both neurological symptoms
and daily ability to function when they used CPAP compared to
patients with apnea who only received usual medical care.
"I think the implications of the study are that patients with stroke
and TIA should receive early diagnostic testing with a sleep study.
If they have sleep apnea then we should treat them before they leave
the hospital," said lead author Dawn M. Bravata, research scientist
at the Regenstrief Institute and Richard L. Rouedeush VA Medical
Center in Indianapolis, Indiana.
For the new analysis, researchers studied 252 adults hospitalized
for an ischemic stroke or a mini-stroke, known as a transient
ischemic attack (TIA). They screened everyone for sleep apnea and
found that roughly three-quarters of patients had the sleep
breathing disorder.
About two-thirds of patients with sleep apnea were assigned to one
of two interventions that included receiving a CPAP machine as well
as training and encouragement in its use. The other third with sleep
apnea served as a control group and received usual medical care,
plus a recommendation at the end of the study to seek CPAP
treatment.
Patients' neurological symptoms and their ability to function in
normal activities like walking and self-care were assessed at the
beginning of the study and six months to one year later.
At follow-up, all of the patients showed improvement in both
neurological symptoms and functional status, however 59 percent of
the patients who used CPAP had neurological symptom scores at or
close to normal, in contrast with just 38 percent of controls.
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"All the evidence suggests if you treat sleep apnea early, the
better your stroke outcome will be. But it would be hard for a
hospital to do. They would have to reconfigure their sleep services
to be acute," Bravata said in a phone interview.
"If physicians could reduce some disability due to post-stroke
events it would be huge," said Michael Twery, director of the
National Heart, Lung and Blood Institute's Center on Sleep Disorders
Research, who wasn't involved in the study.
One of the limitations of the new analysis, which was published in
the Journal of the American Heart Association, is that it was
conducted at only two sites.
A new, Phase Three multicenter study conducted by the National
Institute of Neurological Disorders and Stroke will be more
representative, Twery noted. "It will establish which patients
benefit from a new treatment and how much do they benefit across
many hospital locations."
New designs in CPAP machines have become streamlined and are smaller
than a shoebox. The mask comes in different styles, Bravata said.
"It's sort of like shoe shopping. It's a matter of finding things
you like that fits you very well."
"Treating stroke or TIA patients with CPAP will never replace
traditional therapies. But patients should be asking their
physicians to be tested for sleep apnea if they have symptoms of
it," said Larry Goldstein, chairman of neurology and co-director of
the Kentucky Neuroscience Institute in Lexington, who wasn't
involved in the study.
SOURCE: https://bit.ly/2OJHhXr Journal of the American Heart
Association, online August 15, 2018.
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