Continuous Positive Airway Pressure on Acute Stroke and Obstructive Sleep Apnea

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.

Study Overview

• Status: Completed
• Conditions: Obstructive Sleep Apnea; Stroke, Acute
• Intervention / Treatment: Device: CPAP

• Study Type: Interventional
• Enrollment (Actual): 71
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • New Taipei City, Taiwan
    • Far Eastern Memorial Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Time from onset of stroke symptoms to hospital arrival <2 weeks .
2. Stroke is documented with brain magnetic imaging or computed tomography
3. Competency to provide informed consent.
4. Moderate to severe obstructive sleep apnea being established with the use of a home sleep-study screening device (ApneaLink).
5. Epworth sleepiness scale≦10.

Exclusion Criteria:

1. Having received CPAP for obstructive sleep apnea prior to admission.
2. History of pneumothorax or brain surgery.
3. Coexisting heart failure or renal failure or persistent atrial fibrillation.
4. Unable to wear a nasal or nasal-oral mask.
5. Concomitant uncontrolled infection.
6. Swallowing difficulty or episodes of choking due to stroke
7. Coexisting central nervous diseases such as dementia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CPAP group; Subjects will receive CPAP treatment in addition to optimal standard therapy for acute stroke.	Device: CPAP; CPAP will be given after obstructive sleep apnea being diagnosed in the acute stage of stroke.
No Intervention: Usual-care group; Subjects will receive optimal standard therapy for acute stroke.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in left atrium volume index (LAVI)	Change of LAVI will be assessed by transthoracic echocardiography at baseline and at 3, 6 and 12 months post randomization.	12 months
Serial change of NT-proBNP	Change of NT-proBNP will be assessed at baseline and at 3, 6 and 12 months post randomization.	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neurological and functional assessments-1	Change in National Institutes of Health (NIH) stoke scale will be assessed at baseline ,3, 6 and 12 months post randomization.	12 months
Neurological and functional assessments-2	Change in modified Rankin scale will be assessed at baseline, 3, 6 and 12 months post randomization.	12 months
Neurological and functional assessments-3	Chang in Barthel-ADL index will be assessed at baseline, 3, 6 and 12 months post randomization.	12 months
Change in Quality of life assessments	Change in Epworth sleepiness scale and Medical Outcomes Study 36-Item Short-Form Health Survey at baseline, 3, 6 and 12 months post randomization.	12 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numbers of cardiovascular or cerebrovascular events	Numbers of cardiovascular or cerebrovascular events post randomization	12 months
Time to cardiovascular or cerebrovascular events	Time to cardiovascular or cerebrovascular events post randomization	12 months
Numbers of all-cause hospitalizations	Numbers of hospitalizations for any reason post randomization	12 months
Number of deaths	Numbers of deaths from all causes post randomization	12 months
Time to deaths	Time to deaths from all causes post randomization	12 months

Collaborators and Investigators

• Sponsor: Far Eastern Memorial Hospital
• Investigators: Principal Investigator: Chou-Han Lin, MD, Far Eastern Memorial Hospital

Study record dates

Study Major Dates

• Study Start (Actual): July 9, 2020
• Primary Completion (Actual): December 31, 2024
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: June 30, 2020
• First Submitted That Met QC Criteria: July 2, 2020
• First Posted (Actual): July 7, 2020

Study Record Updates

• Last Update Posted (Estimated): December 17, 2025
• Last Update Submitted That Met QC Criteria: December 15, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: stroke; obstructive sleep apnea; continuous positive airway pressure
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Respiratory Tract Diseases; Respiration Disorders; Sleep Wake Disorders; Apnea; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Apnea Syndromes; Stroke; Sleep Apnea, Obstructive
• Other Study ID Numbers: 109018-E

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No