医学
持续气道正压
冲程(发动机)
随机对照试验
阻塞性睡眠呼吸暂停
睡眠呼吸暂停
人口
临床试验
物理疗法
呼吸暂停
急诊医学
重症监护医学
内科学
机械工程
环境卫生
工程类
作者
Mark I. Boulos,Laavanya Dharmakulaseelan,Devin L. Brown,Richard H. Swartz
出处
期刊:Stroke
[Ovid Technologies (Wolters Kluwer)]
日期:2021-01-01
卷期号:52 (1): 366-372
被引量:19
标识
DOI:10.1161/strokeaha.120.031709
摘要
Few randomized controlled trials have evaluated the effectiveness of continuous positive airway pressure (CPAP) in reducing recurrent vascular events and mortality in poststroke obstructive sleep apnea (OSA). To date, results have been mixed, most studies were underpowered and definitive conclusions are not available. Using lessons learned from prior negative trials in stroke, we reappraise prior randomized controlled trials that examined the use of CPAP in treating poststroke OSA and propose the following considerations: (1) Intervention-based changes, such as ensuring that patients are using CPAP for at least 4 hours per night (eg, through use of improvements in CPAP technology that make it easier for patients to use), as well as considering alternative treatment strategies for poststroke OSA; (2) Population-based changes (ie, including stroke patients with severe and symptomatic OSA and CPAP noncompliers); and (3) Changes to timing of intervention and follow-up (ie, early initiation of CPAP therapy within the first 48 hours of stroke and long-term follow-up calculated in accordance with sample size to ensure adequate power). Given the burden of vascular morbidity and mortality in stroke patients with OSA, there is a strong need to learn from past negative trials and explore innovative stroke prevention strategies to improve stroke-free survival.
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