Positional Therapy After Stroke
Positional Therapy After Stroke
Stroke is the leading cause of adult disability and the third leading cause of death in the
 United States. Unfortunately, there are few therapies that have been proven to improve stroke
 outcome. Sleep apnea is an emerging stroke risk factor and has a well established association
 with higher mortality and poor functional outcome following stroke. Over half of acute stroke
 patients have sleep apnea, suggesting that it may be a important target for therapy.
 Attenuation of sleep apnea severity may result in improved stroke outcomes. However, the
 standard treatment for sleep apnea is not well-tolerated among stroke patients. An
 alternative treatment is avoidance of supine sleep. Supine sleep is very common in acute
 stroke patients, and therefore this treatment may have particular relevance to the stroke
 population. The proposed study will be conducted in two phases. The first phase is a
 randomized, crossover design in which acute stroke patients will be given positional
 treatment (to avoid supine sleep) on one night during their stroke hospitalization. This will
 be compared with another night of sleeping without positional therapy. The order of
 treatments (standard vs positional therapy) will be random. The first phase will demonstrate
 the proof of concept: that stroke patients given positional therapy to avoid supine sleep
 will (1) sleep less on their backs, and (2) will have improved sleep apnea parameters with
 positional therapy. In the second phase, those identified to have sleep apnea will be
 randomized to receive positional therapy at home for three months, or standard therapy. This
 second phase will demonstrate the adherence/feasibility of three months of positional
 therapy, and will allow us to estimate effect size based on a functional outcome measure. The
 data obtained from this pilot clinical trial are essential to plan a large efficacy study.
Inclusion Criteria:

 -  Age 18 or older

 -  Probable ischemic stroke within prior 14 days

 Exclusion Criteria:

 -  Any medical condition precluding the avoidance of supine posture or dictating the need
 for a particular position.

 -  Current use of CPAP (or other PAP), mechanical ventilation, or supplemental oxygen.