Deans' stroke musings: A Randomized Sham-Controlled Trial of Continuous Positive Airway Pressure in Patients Undergoing Intensive Inpatient Rehabilitation after Acute Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, May 31, 2016

A Randomized Sham-Controlled Trial of Continuous Positive Airway Pressure in Patients Undergoing Intensive Inpatient Rehabilitation after Acute Stroke

I was never tested for speep apnea while in the hospital although I did pass the finger pulse oximetry test. One year later I had it tested on my own, quit breathing 6.5 times per hour, mild apnea, got a CPAP anyway. Couldn't stand it.
I highly doubt that sleep apnea has much causation to poor functional recovery.
http://www.neurology.org/content/86/16_Supplement/P3.308.abstract

Sandeep Khot₅,
Arielle Davis₂,₃,
Deborah Crane₅,
Tanzi Patricia₂,₃,
Denise Li Lue₅,
Edward Claflin₄,
Kyra Becker₂,₃,
W. T. Longstreth₁,
Nathaniel Watson₁ and
Martha Billings₁

+Show Affiliations

Published online before print April 8, 2015, Neurology April 5, 2016 vol. 86 no. 16 Supplement P3.308

Abstract

Abstract

Objective: To assess the feasibility of a sham-controlled CPAP trial during stroke rehabilitation and the effect of CPAP on functional recovery.

Background: Obstructive sleep apnea (OSA), present in over 70[percnt] of stroke patients, predicts poor functional outcome after stroke. The impact of OSA treatment on stroke recovery is poorly understood.

Methods: In a pilot randomized, double-blind trial, adult patients with stroke were assigned to auto-titrating or sham-CPAP during inpatient rehabilitation without diagnostic testing for OSA. Change in Functional Independence Measure (FIM), a measure of disability, was assessed between rehabilitation admission and discharge.

Results: Of 125 patients screened over an 18-month period, 65 were eligible and 40 (62[percnt]) were randomized (25 with ischemic and 15 with hemorrhagic stroke). Of the 40 (age 56 ± 12 years, BMI 29.8 ± 5, NIH Stroke Scale, 7.4 ± 4.9 [mean ± SD]), 10 withdrew from the study: 7 from active and 3 from sham (p>0.10). Patients who withdrew were significantly more likely to complain of anxiety with CPAP (p<0.001). For the remaining 30 patients, median duration of CPAP use was 14 days. Average CPAP use was 3.7 hours/night, with at least 4 hours of nightly use among 15 patients. Adherence was not influenced by treatment assignment or stroke severity. In intention-to-treat analyses (n=40), the median change in FIM favored active-CPAP over sham-CPAP but did not reach statistical significance (34 versus 26, p=0.25), except for the cognitive component (6 versus 2.5, p=0.04). The on-treatment analyses (n=30) yielded similar results (total FIM: 32 versus 26, p=0.11; cognitive FIM: 6 versus 2, p=0.06).

Conclusions: A sham-controlled CPAP trial among stroke rehabilitation patients is feasible and treatment with CPAP may benefit recovery, especially of cognitive function. Tolerance and adherence must be improved before the full benefits of CPAP on functional recovery can be accurately assessed in larger trials.