CPAP Effect on New Vascular Events

CPAP Effect on New Vascular Events

   In the current study, we found more frequent occurrence of new vascular events in the group that was not treated with CPAP than the CPAP group, though this difference was not found to be statistically significant. Tomfohr extensively reviewed the effect of CPAP on stroke survivors, and summarized that most published studies were observational. The randomized studies evaluating the difference in new vascular event occurrence rate with CPAP after stroke have either included patients with acute transient ischemic attack or have been conducted in an acute stroke setting, after which much sleep-disordered breathing could subside or evolve.

 Although the study on patients with transient ischemic attack found a significant difference brought about in the new vascular event occurrence rate, the latter study (on patients with acute stroke) found no significant difference in the occurrence of new vascular events. Martinez-Garcia et al. reported a significant decrease in mortality and the number of new vascular events through their 5- to 7-year follow-up observational studies. In the observational studies, the numbers included were similar to those in our study.

However, they used level 3 PSG studies that may have biased them toward the inclusion and randomization of patients with more severe OSA than those in our study. They also did not carry out titration with CPAP prior to the initiation of nightly use by patients. In comparison with the aforementioned studies, ours is the first RCT with the most appropriate poststroke timing of PSG and randomization. We also used level 1 sleep studies and in-laboratory CPAP titration prior to nightly use by patients.

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