Intensive Continuous Positive Airway Pressure Adherence Program During Stroke Rehabilitation

Well first you need a protocol to identify that sleep apnea exists. Then you need to come up with something other than CPAP that treats sleep apnea. I couldn't sleep at all with a CPAP.  If you don't realize that CPAP adherence is a problem that needs a different solution then you really don't belong solving stroke problems.  Status quo is not acceptable.

Intensive Continuous Positive Airway Pressure Adherence Program During Stroke Rehabilitation

Sandeep Khot

,

Heather Barnett

,

Arielle Davis

,

Jenny Siv

,

Deborah Crane

,

Allison Kunze

,

Denise Li Lue

,

Aaron Bunnell

,

Barbara McCann

,

Charles Bombardier

,

W.T. Longstreth Jr

,

Nathaniel Watson

,

Martha Billings

Originally publishedhttps://doi.org/10.1161/STROKEAHA.119.024795Stroke. ;0

Abstract

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.