From the Journals

Stroke patients benefited from CPAP


Key clinical point: Continuous positive airway pressure (CPAP) treatment may prevent vascular events in patients with stroke who have OSA.

Major finding: There was one vascular event (3.33%) at 12 months for CPAP-treated patients, versus six events (15%) in non-CPAP patients, though the difference was not significant (P = .23).

Study details: A single-blind, randomized, controlled trial including 70 patients with imaging-confirmed first arterial stroke and OSA.

Disclosures: The authors reported no conflicts of interest related to the study.

Source: Gupta A et al. J Clin Sleep Med. 2018 Mar 30. pii:jc-17-00230.



For stroke patients with obstructive sleep apnea using continuous positive airway pressure (CPAP) may improve stroke outcomes and reduce the recurrence of vascular events, the results of a randomized study suggest.

Obstructive sleep apnea is present in 50%-80% of patients with stroke, previous studies show, and its presence is associated with impaired function and cognition, delirium, and longer rehabilitation time, among other negative impacts, wrote Anupama Gupta, PhD, and her coauthors from the All India Institute of Medical Sciences, New Delhi, in the Journal of Clinical Sleep Medicine. Although multiple trials have shown a positive effect of CPAP on stroke recovery, relatively few investigations have looked specifically at whether the intervention prevents subsequent vascular events.

This study included 70 patients with first arterial stroke at least 6 weeks after the event and moderate to severe obstructive sleep apnea (OSA). These patients were randomized to be treated with CPAP or standard medical care. Initially, 34 patients were treated with CPAP and 36 were treated with standard care. Four of the patients receiving CPAP crossed over to the control group during the trial.

Patients’ clinical stroke outcomes were categorized in accordance with the Modified Rankin Scale (mRS), which is most widely used to assess disability and dependence outcomes among patients with stroke.

Significantly more patients who were treated with CPAP experienced an improvement in their mRS score by at least 1 point, when assessed at both 6 and 12 months following entrance into the study. Specifically, 53% (16) of patients in the CPAP group had an improvement of at least 1 point in their mRS score at 12 months, compared with 27% (11) of patients who did not use CPAP (P = .03).

“These differences are statistically significant, as well as clinically meaningful and relevant,” Dr. Gupta and her colleagues said in their report.

This finding was consistent with what researchers have seen in some earlier studies of stroke patients who used CPAP, the researchers wrote.

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