Authors | N (assigned to PAP) | Setting | Diagnostic testing | Criteria for treatment/type of treatment | Timing of sleep study or start of treatment | Duration of treatment | Major findings (differences in outcomes between groups) | P valuea |
---|---|---|---|---|---|---|---|---|
Hsu et al60 | 63 (31) | Stroke rehabilitation unit | Portable monitor | AHI ≥ 30 ACPAP | Around 3 weeks after stroke | 8 weeks | Barthel Index NIH Stroke Scale SF-36 physical / mental | .17 .62 .02 /.23 |
Parra et al61 | 30 (15) | Inpatient neurology | Portable monitor | AHI ≥ 20 ACPAP to fixed CPAP | CPAP days 3–6 | 24 months | 1 month / 24 months Barthel Index > 1 point Rankin Scale > 1 point Canadian Neurologic Scale > 0.5 | .57 / NS .002 / NS .04 / NS |
Ryan et al62 | 44 (25) | Inpatient stroke rehabilitation unit | PSG | AHI ≥ 15 CPAP titrated by PSG | Around 3 weeks after stroke | 1 month | Epworth Sleepiness Scale Canadian Neurologic Scale Functional Independence Measure | < .0001 < .001 .07 |
Bravata et al63 | 55 (31) | Inpatient stroke unit | PSG | No AHI cutoff ACPAP | ACPAP started within 48 hours of symptom onset | 1 month | Improvement in NIH Stroke Scale Vascular events (transient ischemic attack, stroke, myocardial infarction, heart failure, death) | .03 .31 |
Parra et al64 | 126 (57) | Inpatient stroke unit | Portable monitor | AHI ≥ 20 ACPAP to fixed CPAP | CPAP days 3–6 | 5 years | Cardiovascular survival Cardiovascular event-free survival | .015 .059 |
Khot et al65 | 40 (20) | Inpatient rehabilitation unit | Portable monitor or PSG | No AHI cutoff ACPAP or sham ACPAP | ACPAP around day 10 | 2 weeks | Functional Independence Measure-Total Functional Independence Measure-Cognitive Functional Independence Measure-Motor | .25 .04 .42 |
Aaronson et al66 | 36 (20) | Inpatient stroke rehabilitation unit | Portable monitor | AHI ≥ 15 CPAP | CPAP at 3–4 weeks after stroke | 4 weeks | NIH Stroke Scale Canadian Neurologic Scale Activities of Daily Living / USER Improvement in attention Improvement in executive function | .08 .08 .11 .048 .001 |
Gupta et al67 | 70 (34) | Neurologic inpatient or outpatient clinic | PSG | AHI > 15 Fixed CPAP to ACPAP | CPAP around 6–8 weeks after stroke | 12 months | Blood pressure New cardiovascular event Barthel Index > 1 point Modified Rankin Scale > 1 point Epworth Sleepiness Scale | NS .23 .96 .03 < .0001 |
↵a When statistically significant (P < .05), the difference favors CPAP.
ACPAP = autoadjusting CPAP; AHI = apnea-hypopnea index; CPAP = continuous positive airway pressure; NIH = National Institutes of Health; NS = nonsignificant; PAP = positive airway pressure; PSG = polysomnography; SF-36 = Short Form 36; USER = Utrecht Scale for Evaluation of Rehabilitation