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CPAP treatment linked to lower mortality in stroke patients with OSA
June 26, 2009Stroke patients with obstructive sleep apnea (OSA) who undergo treatment with continuous positive airway pressure (CPAP) following their stroke may substantially reduce their risk of death, according to Spanish research to be published in the July 1 issue of the American Journal of Respiratory and Critical Care Medicine.
"Our results suggest that patients with ischemic stroke and moderate to severe OSA showed an increased mortality risk," wrote lead author, Miguel Angel Martínez-García, M.D., of Requena General Hospital in Valencia, Spain. "CPAP treatment, although tolerated by only a small percentage of patients, is associated with a reduction in this excess risk and achieves a mortality [rate] similar to patients without OSA or with mild disease."
The study identified and recruited 166 consecutive patients from Requena General Hospital who had had an ischemic stroke and subsequently were diagnosed with sleep apnea in sleep study tests. The mean age was 73.3. CPAP treatment was offered to the 96 patients who scored above 20 on the apnea-hypopnea index, indicating moderate-to-severe OSA. Each patient was followed for five years, reporting to the outpatient clinic and one, three and six months, then at six month intervals until the conclusion of the study. They were evaluated for general status, new cardiovascular events, CPAP adherence and death.
At the conclusion of the five year follow-up period, nearly half (48.8 percent) the original study group had died and only 28 of the original 96 were considered to be fully compliant with CPAP treatment. After adjusting for 13 potentially confounding variables, including age, gender, co-morbidities and current smoking, the researchers found that those with moderate to severe OSA who had not complied with CPAP treatment had nearly 1.6 times the risk of death compared to patients who tolerated CPAP, whereas those with moderate-to-severe disease who had tolerated CPAP had similar risk of death than patients without sleep apnea or mild disease.
"Our results suggest that moderate to severe OSA in patients with stroke has an unfavorable effect on long-term mortality. CPAP treatment is associated with a reduction in this excess risk," concluded Dr. Martínez-García in the article.
However, while the researchers controlled for the measurable variables they anticipated as potentially contributing to the link between CPAP compliance and risk of death following stroke, they acknowledge that certain variables were impossible to adequately anticipate or measure. "Patients who did not tolerate CPAP might have a special profile; [they] may have poor adherence to other types of treatment, including treatment of cardiovascular prevention, which would carry with it a higher risk of stroke," said Dr. Martínez-García. "However, the variables that measure the adherence of all the treatments in these patients are very difficult to analyze because patients often take many medications. This is a limitation of our study."
Further research in the form of a long-term, multi-center study with enough statistical power to verify the effect of CPAP on mortality in these patients is necessary before drawing any direct causal link between CPAP treatment and risk of death after stroke, said Dr. Martínez-García.
Other important goals should be immediately improving CPAP compliance within the elderly stroke population, he suggested. "One of the most important objectives is to increase CPAP adherence to treatment in stroke patients. This is a very difficult objective because of the special characteristics of stroke patients, who tend to be elderly, may have neurological damages, and whose symptoms related to sleep apnea are less likely to rapidly improve with CPAP," said Dr. Martínez-García. "Spending time to explain the benefits of treatment in terms of cardiovascular prognosis, being in direct contact with them, educational programs, offering them the possibility of sleep lab assessments if they have problems with CPAP treatment and improvements in the comfort of the devices would be the activities could do to improve the adherence to CPAP treatment."
American Thoracic Society
At the conclusion of the five year follow-up period, nearly half (48.8 percent) the original study group had died and only 28 of the original 96 were considered to be fully compliant with CPAP treatment. After adjusting for 13 potentially confounding variables, including age, gender, co-morbidities and current smoking, the researchers found that those with moderate to severe OSA who had not complied with CPAP treatment had nearly 1.6 times the risk of death compared to patients who tolerated CPAP, whereas those with moderate-to-severe disease who had tolerated CPAP had similar risk of death than patients without sleep apnea or mild disease.
"Our results suggest that moderate to severe OSA in patients with stroke has an unfavorable effect on long-term mortality. CPAP treatment is associated with a reduction in this excess risk," concluded Dr. Martínez-García in the article.
However, while the researchers controlled for the measurable variables they anticipated as potentially contributing to the link between CPAP compliance and risk of death following stroke, they acknowledge that certain variables were impossible to adequately anticipate or measure. "Patients who did not tolerate CPAP might have a special profile; [they] may have poor adherence to other types of treatment, including treatment of cardiovascular prevention, which would carry with it a higher risk of stroke," said Dr. Martínez-García. "However, the variables that measure the adherence of all the treatments in these patients are very difficult to analyze because patients often take many medications. This is a limitation of our study."
Further research in the form of a long-term, multi-center study with enough statistical power to verify the effect of CPAP on mortality in these patients is necessary before drawing any direct causal link between CPAP treatment and risk of death after stroke, said Dr. Martínez-García.
Other important goals should be immediately improving CPAP compliance within the elderly stroke population, he suggested. "One of the most important objectives is to increase CPAP adherence to treatment in stroke patients. This is a very difficult objective because of the special characteristics of stroke patients, who tend to be elderly, may have neurological damages, and whose symptoms related to sleep apnea are less likely to rapidly improve with CPAP," said Dr. Martínez-García. "Spending time to explain the benefits of treatment in terms of cardiovascular prognosis, being in direct contact with them, educational programs, offering them the possibility of sleep lab assessments if they have problems with CPAP treatment and improvements in the comfort of the devices would be the activities could do to improve the adherence to CPAP treatment."
American Thoracic Society
Obstructive Sleep Apnea Current Events and Obstructive Sleep Apnea News RSSImproved diet and exercise alone unlikely to cure obstructive sleep apnea in obese patients
A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that while a strict diet and exercise program may benefit obese patients with mild to moderate obstructive sleep apnea (OSA), it is unlikely to eliminate the condition.
Minimally invasive procedure effective for treating snoring
Radiofrequency ablation, a procedure that uses heat to shrink the tissue of the soft palate, is an effective and minimally invasive procedure that can be used to treat patients who snore.
Many patients with sleep apnea also suffer from GI tract conditions
Patients who suffer from obstructive sleep apnea (OSA) also tend to have additional gastrointestinal (GI) tract conditions, such as gastric reflux and hiatal hernia, which form at the opening in your diaphragm where your food pipe (esophagus) joins your stomach.
Stress, fatigue plague patients with allergic rhinitis and obstructive sleep apnea
Patients who suffer from both allergic rhinitis and obstructive sleep apnea (OSA) may experience escalated symptoms of stress and fatigue.
Severe sleep apnea tied to increased risk of death
Moderate to severe obstructive sleep apnea is associated with an increased risk of death from any cause in middle-aged adults, especially men, according to new results from a landmark study supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).
Obstructive sleep apnea is prevalent in adults with Down syndrome
A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine shows that adults with Down syndrome also frequently suffer from obstructive sleep apnea (OSA).
Study finds increased 'sibling risk' of obstructive sleep apnea in children
A study in the Aug. 1 issue of the journal SLEEP indicates that children have an increased risk of developing obstructive sleep apnea (OSA) if they have at least one sibling who has been diagnosed with the sleep disorder.
Benefits from upper airway surgery for sleep apnea found to equal CPAP
Adults who struggle with CPAP treatment for obstructive sleep apnea (OSA) should be considered candidates for reconstructive surgery on the upper airway, because it holds the same quality-of-life (QOL) benefits but with more permanence.
Biomarker of breathing control abnormality associated with hypertension and stroke
A study in the July 1 issue of the journal SLEEP identified a distinct ECG-derived spectrographic phenotype, designated as narrow-band elevated low frequency coupling (e-LFCNB), that is associated with prevalent hypertension, stroke, greater severity of sleep disordered breathing and sleep fragmentation in patients suffering from obstructive sleep apnea (OSA).
Older men with breathing problems during sleep more likely to have irregular heartbeats
Increasingly severe sleep-related breathing disorders in older men appear to be associated with a greater risk of abnormal heart rhythms (arrhythmias).
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