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Clinical Investigations: SLEEP |

Continuous Positive Airway Pressure Treatment in Sleep Apnea Prevents New Vascular Events After Ischemic Stroke*

Miguel Ángel Martínez-García, MD; Rafael Galiano-Blancart, MD; Pilar Román-Sánchez, MD; Juan-José Soler-Cataluña, MD; Luis Cabero-Salt, MD; Enmanuel Salcedo-Maiques, MD
Author and Funding Information

*From the Pneumology (Drs. Martínez-García and Soler-Cataluña) and Neurology Units (Dr. Galiano-Blancart), and Service of Internal Medicine (Drs. Román-Sánchez, Cabero-Salt, and Salcedo-Maiques), Requena General Hospital, Valencia, Spain.

Correspondence to: Miguel Ángel Martínez-García, MD, Hospital General de Requena, Unidad de Neumología (Servicio de Medicina Interna), Paraje Casa Blanca s/n, 46320-Requena, Valencia, Spain; e-mail: med013413@nacom.es



Chest. 2005;128(4):2123-2129. doi:10.1378/chest.128.4.2123
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Study objectives: A study was made of the role of continuous positive airway pressure (CPAP) treatment in the prevention of new vascular events following ischemic stroke or transient ischemic attack.

Design: Prospective study.

Patients and interventions: Demographic data, vascular risk factors, clinical manifestations associated to sleep apnea-hypopnea syndrome, and neurologic parameters were recorded in a group of patients presenting with acute ischemic stroke at least 2 months previously. A polygraphic study was carried out 2 months after the acute episode in all patients, with the prescription of CPAP in the event of an apnea-hypopnea index (AHI) ≥ 20. Two groups were defined: patients who could tolerate CPAP (group 1), and patients who could not tolerate CPAP after 1 month of initial adaptation (group 2). Patients with an AHI < 20 were excluded. The incidence of new vascular events was evaluated throughout follow-up (18 months) in all patients, with an analysis of the role of CPAP in protecting the patients against such events.

Results: Ninety-five patients were studied. Fifty-one patients (53.7%; mean age, 72.7 ± 9.4 years [± SD]) presented with an AHI ≥ 20, and 15 patients (29.4%) tolerated CPAP. The incidence of new vascular events was greater in group 2 (6.7%) vs group 1 (36.1%; long-rank, p = 0.03). Intolerance of CPAP increased the probability of a new vascular event fivefold (odds ratio, 5.09) adjusted for other vascular risk factors and neurologic indexes.

Conclusions: We concluded that CPAP treatment during 18 months in patients with an AHI ≥ 20 afforded significant protection against new vascular events after ischemic stroke.

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