Continuous Positive Airway Pressure Ventilation for Acute Ischemic Stroke
A Randomized Feasibility Study
Background and Purpose—Sleep-related breathing disorders occur frequently after stroke. We assessed the feasibility of continuous positive airway pressure (CPAP) treatment initiated in the first night after stroke.
Methods—In this open-label, parallel-group trial, 50 patients were randomly assigned to the CPAP therapy or to the control group. All patients underwent polysomnography in the fourth night. Intervention patients received CPAP therapy for 3 nights starting the first night after stroke onset and for an additional 4 nights when polysomnography revealed an apnea–hypopnea index >10/hour. The primary end point was feasibility defined as apnea–hypopnea index reduction under CPAP treatment, nursing workload, and CPAP adherence.
Results—The apnea–hypopnea index under CPAP treatment was significantly reduced (32.2±25.3–9.8±6.6, P=0.0001). Nursing workload did not significantly differ between the CPAP (n=25) and the control group (n=25; P=0.741). Ten patients (40.0%) had excellent CPAP use, 14 patients (56.0%) had some use, and 1 patient (4.0%) had no use. There was a trend toward greater National Institutes of Health Stroke Scale score improvement until Day 8 in patients on CPAP (2.00 versus 1.40, P=0.092) and a significantly greater National Institutes of Health Stroke Scale score improvement in patients with excellent CPAP use when compared with control patients (2.30 versus 1.40, P=0.022).
Conclusions—CPAP therapy initiated in the first night after stroke seems to be feasible and was not associated with neurological deterioration.
- Received August 29, 2011.
- Revision received October 18, 2011.
- Accepted October 24, 2011.
- © 2011 American Heart Association, Inc.