Abstract
Purpose
To evaluate outcomes, outside of a clinical trial setting, of a protocol utilizing overnight oximetry (NOx) to risk stratify post-stroke patients for obstructive sleep apnea (OSA) followed by autoadjusting continuous positive airway pressure (APAP) treatment in patients considered high risk for OSA.
Methods
Retrospective observational study of post-stroke patients at an academic inpatient stroke rehabilitation facility. Patients underwent NOx, and those at high risk for OSA (oxygen desaturation index 3% > 10 per hour) were attempted on a trial of APAP, and further stratified into high risk adherent with treatment (HRAT) or high-risk failed treatment (HRFT). Change in functional independence measure (FIM) was used to assess recovery.
Results
Two hundred twenty-four post-stroke patients underwent NOx, with 120 (53%) considered high risk for OSA. Twelve (10%) were compliant with APAP treatment (> 4 h/night on > 70% of nights). No difference in change in FIM scores was observed for HRAT versus HRFT [total FIM change − 5.8, 95% CI (− 13.9, 2.2); motor FIM change − 4.5, 95% CI (− 11.5, 2.4); cognitive FIM change − 1.3, 95% CI (−3.8, 1.2)]. A subgroup analysis matched 14 HRAT patients (using adherence criterion of APAP usage > 50% of nights) to 35 HRFT patients. A statistically significant, but clinically irrelevant, difference in total FIM change was observed (HRAT vs HRFT, difference between means − 5.2, p = 0.03).
Conclusions
The use of APAP in high-risk patients was poorly tolerated and did not improve post-stroke recovery. Further studies with larger sample sizes are needed to determine the effect of APAP treatment on short-term recovery.
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Abbreviations
- ACPAP:
-
autoadjusting continuous positive airway pressure
- AHI:
-
apnea-hypopnea index
- BMI:
-
body mass index
- CAD:
-
coronary artery disease
- CHF:
-
congestive heart failure
- COPD:
-
chronic obstructive pulmonary disease
- CPAP:
-
continuous positive airway pressure
- CSA:
-
central sleep apnea
- CVA:
-
cerebrovascular accident
- DBM:
-
difference between means
- DM:
-
diabetes mellitus
- FIM:
-
functional independence measure
- HFpEF:
-
heart failure with preserved ejection fraction
- HFrEF:
-
heart failure with reduced ejection fraction
- HRAT:
-
high risk adherent with treatment
- HRFT:
-
high risk failed treatment
- HTN:
-
hypertension
- IRF:
-
inpatient rehabilitation facility
- LR:
-
low risk
- NOx:
-
nocturnal oximetry
- ODI3%:
-
oxygen desaturation index 3%
- OSA:
-
obstructive sleep apnea
- PAP:
-
positive airway pressure
- PSG:
-
polysomnography
- REI:
-
respiratory event index
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Mr. McKee declares that he has no conflict of interest. Dr. Wilson declares that he has no conflict of interest. Dr. Auckley has received research grants from Medtronics.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was waived by the IRB giving the retrospective nature of this study of current clinical practice at our institution. All data was de-identified.
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McKee, Z., Wilson, R.D. & Auckley, D.H. Evaluation of an OSA risk stratifying and treatment protocol during inpatient rehabilitation of post-stroke patients. Sleep Breath 24, 513–521 (2020). https://doi.org/10.1007/s11325-019-01887-3
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DOI: https://doi.org/10.1007/s11325-019-01887-3