Sleep-disordered breathing after stroke: a randomised controlled trial of continuous positive airway pressure
- 1Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- 2Department of Clinical Neuroscience, Western General Hospital, Edinburgh
- Correspondence to: N J Douglas Department of Sleep Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; n.j.douglas{at}ed.ac.uk
- Received 21 December 2005
- Accepted 7 June 2006
- Revised 5 June 2006
- Published Online First 13 June 2006
Abstract
Background: Sleep-disordered breathing (SDB) is common after stroke, but it is unclear whether it should be treated.
Objective: To conduct a randomised controlled trial of continuous positive airway pressure (CPAP) after stroke.
Methods: Patients with stroke with ≥30 apnoeas and hypopnoeas per hour ((A+H)/h) with predominant obstructive sleep apnoea or hypopnoea were randomised to either CPAP treatment or conservative treatment for 8 weeks. Outcomes were measured blind to treatment allocation at 8 weeks and 6 months after the stroke. The primary outcome was physical function on the Nottingham Extended Activities of Daily Living Scale.
Results: Of 658 patients with stroke screened, only 71 (10.7%) were eligible and consented to a sleep study 14–19 days after stroke. 66 patients completed the sleep study (21 women; mean age 72 years), 33 (50%) had ≥30 (A+H)/h that were predominantly obstructive. 15 were randomised to CPAP treatment and 15 to conventional treatment. Despite intensive efforts, objective use of CPAP was poor, averaging 1.4 h a night. CPAP treatment resulted in no significant improvements (p>0.1) in the primary outcome or in neurological function or sleepiness, and in poorer health status on some measures.
Conclusions: This trial showed no benefit from CPAP treatment, the relevance of the observed detrimental effects is questionable. Even in our highly selected patients with stroke, use of CPAP was poor. At present, CPAP treatment should be advocated for patients with stroke only if they have symptoms of SDB.
- ACE, Addenbrooke’s Cognitive Examination
- CPAP, continuous positive airway pressure
- EADL, Extended Activities of Daily Living
- HADS, Hospital Anxiety and Depression Scale
- IQR, interquartile range
- RCT, randomised controlled trial
- SDB, sleep-disordered breathing
Footnotes
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Published Online First 19 June 2006
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Funding: This study was funded by Chest, Heart and Stroke Scotland (RO1/A54).
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Competing interests: NJD is a medical adviser to ResMed Ltd, a company manufacturing CPAP machines.
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Ethics approval: Ethics approval was obtained from the Lothian Research Ethics Committee (reference MREC/2000/4/44). Trust management approval was given by the Research & Developmental Office on behalf of the Trust Chief Executive and Medical Director (Reference R&D/99/17/08). All participants gave written informed consent.
