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

1. Sandeep Khot₅,
2. Arielle Davis₂,₃,
3. Deborah Crane₅,
4. Tanzi Patricia₂,₃,
5. Denise Li Lue₅,
6. Edward Claflin₄,
7. Kyra Becker₂,₃,
8. W. T. Longstreth₁,
9. Nathaniel Watson₁ and
10. Martha Billings₁

+Show Affiliations

1. 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.