Early Treatment of Obstructive Apnea and Stroke Outcome

Abstract

747 Letter to the Editor—Parra and Arboix We have read with attention and great interest the article by Bravata et al.1 recently published in this journal, about the feasibility of using early nasal CPAP (continuous positive airway pressure) treatment in patients with ischemic stroke, and its beneficial effects on their neurological recovery after a 1-month follow-up. We have also recently published similar results from a randomized controlled trial with early nasal CPAP treatment in patients with ischemic first-ever stroke. We included 141 selected patients with AHI ≥ 20 events/h: 71 patients (with only 14 refusing nasal CPAP treatment) in the intervention group and 69 patients in the control group. The percentage of patients with neurological improvement 1 month after stroke was significantly higher in the nasal CPAP group (Rankin scale 90.9 of versus 56.3% [P < 0.01]; Canadian scale 88.2 of versus 72.7% [P < 0.05]).2 Our study differed in that nasal CPAP treatment was initiated slightly later, although still in the acute period after stroke onset (between 3-6 days), since our design included a diagnostic sleep study prior to randomization. Considering the high prevalence of sleep breathing disorders (SBD) in stroke patients3 and the potential deleterious effects of apnea consequences, which could be corrected by nasal CPAP,4 we think the methodological approach of Bravata et al. is practical, daring and clever. This is even more so, if we bear in mind the effect of a better potential recovery of the penumbra area.5 We agree with the authors that nasal CPAP is worthy of considerations in such cases and that the earlier the treatment is introduced, the more the beneficial options gained. Nevertheless, the decision to apply it can be a more comfortable one for physicians if they have the prior opportunity to perform a respiratory polygraphy. If this is not possible, however, we think starting with nasal CPAP could be a good option in selected patients with a high probability of having SDB and also a high probability of good compliance, since this treatment does not have any deleterious effects, in our experience. However, the presence of central apneas in some of these patients could be a problem for nasal CPAP use and compliance. LETTER TO THE EDITOR