Continuous Positive Airway Pressure Ventilation for Acute Ischemic Stroke: A Randomized Feasibility Study

• Published in: Stroke (1970) Vol. 43; no. 4; pp. 1137 - 1139
• Main Authors: MINNERUP, Jens, ANDREAS RITTER, Martin, DZIEWAS, Rainer, WERSCHING, Heike, KEMMLING, André, OKEGWO, Angelika, SCHMIDT, Antje, SCHILLING, Matthias, BERND RINGELSTEIN, E, SCHABITZ, Wolf Riidiger, YOUNG, Peter
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.04.2012
• Subjects: Aged; Biological and medical sciences; Brain Ischemia - physiopathology; Brain Ischemia - therapy; Continuous Positive Airway Pressure; Feasibility Studies; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Polysomnography - methods; Sleep Apnea Syndromes - physiopathology; Sleep Apnea Syndromes - therapy; Stroke - physiopathology; Stroke - therapy; Time Factors; Vascular diseases and vascular malformations of the nervous system; Vascular disease; Cerebral infarction; Stroke; Nervous system diseases; Positive pressure; Central nervous system disease; Brain ischemia; Cardiovascular disease; continuous positive airway pressure ventilation; Cerebrovascular disease; Cerebral disorder
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.111.637611

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. 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. 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). CPAP therapy initiated in the first night after stroke seems to be feasible and was not associated with neurological deterioration. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT00151177.