Background and Purpose—
Continuous
positive airway pressure (CPAP) for the treatment of obstructive sleep
apnea may improve stroke recovery, but adherence is poor. We assessed
the effectiveness of an intensive CPAP adherence program during and
after inpatient stroke rehabilitation on 3-month adherence and stroke
recovery.
Methods—
In
a single-arm study, 90 stroke rehabilitation patients were enrolled
into an intensive CPAP adherence program. CPAP was continued after a
run-in among qualifying patients with evidence of obstructive sleep
apnea. The primary outcome was CPAP adherence, defined as ≥4 hours of
use on ≥70% of days, over 3 months.
Results—
A
total of 62 patients qualified for continued CPAP and 52 of these were
willing to continue CPAP after discharge from rehabilitation. At 3
months, the average daily CPAP use was 4.7 hours (SD 2.6), and 32/52
(62%) patients were adherent. Factors significantly associated with
adherence included more severe stroke, aphasia, and white race. Compared
with nonadherent patients, adherent patients experienced greater
improvements in the cognitive component of the Functional Independence
Measure (
P=0.02) and in the National Institutes of Health Stroke scale (
P=0.03).
Conclusions—
This
intensive CPAP adherence program initiated during stroke rehabilitation
can lead to CPAP adherence in the majority of patients with evidence of
obstructive sleep apnea, including those with more severe stroke and
aphasia, and may promote recovery.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov. Unique identifier: NCT02809430.
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