Obstructive Sleep Apnea Clinical Trial
Official title:
Cardiovascular Effects of Continuous Positive Airway Pressure in Patients With Acute Stroke and Obstructive Sleep Apnea
Stroke affects 16.9 million individuals each year and is the second leading cause of death
worldwide. Despite advances in pharmacologic therapy, morbidity , mortality and rates of
hospitalization for stroke remain high. These data emphasize the importance of identifying
all treatable conditions that could aggravate stroke. One such condition is obstructive sleep
apnea (OSA).
Sleep-related breathing disorders, including obstructive and central sleep apnea, often
coexist with stroke. Compared to the general population, in whom OSA is the most common form
of this breathing disorder with recent prevalence estimates of 22% of male and 17% of female
, in the stroke population, the prevalence of OSA is much greater at 70% . Several randomized
controlledtrials on OSA patients with stroke in acute or sub-acute stage showed that treating
OSA with continuous positive airway pressure (CPAP) improved motor and functional outcomes,
accelerated neurological recovery.Apart from the benefits in better neurological outcomes,
secondary analyses of SAVE study suggested that CPAP treatment potentially help to reduce
recurrence of stroke. Nevertheless, we don't have evidence yet from randomized control
studies to prove CPAP treatment would reduce the recurrence of cardiovascular or
cerebrovascular events.
Traditionally, recurrence of cardiovascular or cerebrovascular events uses documented
mortality, morbidity or hospitalization for heart failure, acute coronary syndrome or stroke
as clinical endpoints. Recently, several studies showed that enlarged left atrium (LA) can
serve as a predictor for recurrent stroke or cardiovascular events. On the other hand, a
growing body of studies demonstrated that CPAP treatment reduce size of LA in those with OSA.
Notably, all of these studies above are observational or retrospective in nature. To date,
there are no prospective longitudinal randomized controlled trials reporting the effect of
CPAP treatment of OSA on the change of size of LA. We therefore will undertake a randomized ,
controlled trial involving patients with stroke to test the primary hypothesis that treatment
of OSA with CPAP would reduce the size of LA.
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