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Randomized Controlled Trial
. 2017 Sep;21(3):713-725.
doi: 10.1007/s11325-017-1494-5. Epub 2017 Apr 6.

Diagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy

Dawn M Bravata  1   2   3   4   5 , Vincent McClain  6 , Charles Austin  7 , Jared Ferguson  7 , Nicholas Burrus  8   9 , Edward J Miech  8   9   6   10 , Marianne S Matthias  8   6   11 , Neale Chumbler  12 , Susan Ofner  13 , Brian Foresman  7   14 , Jason Sico  15   16   17 , Carlos A Vaz Fragoso  15   16 , Linda S Williams  8   9   18   6 , Rajiv Agarwal  7   14 , John Concato  16   19 , H Klar Yaggi  15   16
Affiliations
Randomized Controlled Trial

Diagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy

Dawn M Bravata et al. Sleep Breath. 2017 Sep.

Abstract

Background: Obstructive sleep apnea is common and associated with poor outcomes after stroke or transient ischemic attack (TIA). We sought to determine whether the intervention strategy improved sleep apnea detection, obstructive sleep apnea (OSA) treatment, and hypertension control among patients with chronic cerebrovascular disease and hypertension.

Methods: In this randomized controlled strategy trial intervention, patients received unattended polysomnography at baseline, and patients with OSA (apnea-hypopnea index ≥5 events/h) received auto-titrating continuous positive airway pressure (CPAP) for up to 1 year. Control patients received usual care and unattended polysomnography at the end of the study, to identify undiagnosed OSA. Both groups received 24-h blood pressure assessments at baseline and end of the study. "Excellent" CPAP adherence was defined as cumulative use of ≥4 h/night for ≥70% of the nights.

Results: Among 225 randomized patients (115 control; 110 intervention), 61.9% (120/194) had sleep apnea. The strategy successfully diagnosed sleep apnea with 97.1% (102/105) valid studies; 90.6% (48/53, 95% CI 82.7-98.4%) of sleep apnea was undiagnosed among control patients. The intervention improved long-term excellent CPAP use: 38.6% (22/57) intervention versus 0% (0/2) control (p < 0.0001). The intervention did not improve hypertension control in this population with well-controlled baseline blood pressure: intervention, 132.7 mmHg (±standard deviation, 14.1) versus control, 133.8 mmHg (±14.0) (adjusted difference, -1.1 mmHg, 95% CI (-4.2, 2.0)), p = 0.48).

Conclusions: Patients with cerebrovascular disease and hypertension have a high prevalence of OSA. The use of portable polysomnography, and auto-titrating CPAP in the patients' homes, improved both the diagnosis and the treatment for sleep apnea compared with usual care but did not lower blood pressure.

Keywords: Ischemic stroke; Sleep apnea diagnosis; Sleep apnea treatment; Transient ischemic attack.

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Conflict of interest statement

This study (NCT00984308) received institutional review board approval; patients provided written informed consent.

Figures

Fig. 1
Fig. 1
Patient screening, recruitment, and retention flow
Fig. 2
Fig. 2
Receipt of polysomnography and continuous positive airway pressure
Fig. 3
Fig. 3
Patterns of continuous positive airway pressure over a 1-year period
See this image and copyright information in PMC

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