Continuous Positive Airway Pressure for the Treatment of Stroke
Continuous Positive Airway Pressure for the Treatment of Stroke
New stroke therapies are needed. This study seeks to provide the preliminary data needed to
 plan a future study that will evaluate the efficacy of using continuous positive airway
 pressure (CPAP) to treat stroke patients who have sleep apnea. Our goal is to use this
 therapy to reduce stroke symptom severity.
BACKGROUND Sleep apnea occurs in 60-96% of stroke survivors and is associated with poor
 functional recovery and higher post-stroke mortality. Among patients without stroke,
 continuous positive airway pressure (CPAP) is a safe and effective treatment for sleep apnea.
 This feasibility pilot study is a step in planning a future efficacy trial of CPAP for
 patients with acute ischemic stroke.

 OBJECTIVES The primary objectives are, among acute ischemic stroke patients, to: (1)
 determine the feasibility of performing polysomnography; (2) refine the process for providing
 CPAP within 48-hours of stroke onset; and (3) determine the effect of CPAP on blood pressure.

 METHODS This randomized controlled feasibility study will enroll 100 acute ischemic stroke
 patients. Intervention patients (N=60) receive CPAP within 48 hours of stroke onset and
 continuing for up to 30 days. At 30 days post-enrollment, the intervention patients undergo
 unattended polysomnography. Control (N=40) patients receive unattended polysomnography at
 baseline and after 30 days.

 SIGNIFICANCE CPAP represents an important new potential therapy for acute stroke. CPAP may
 reduce both the neurological symptom severity of the acute stroke and prevent stroke
 recurrence.
Inclusion Criteria: acute ischemic stroke with NIH Stroke Scale >=2 -

 Exclusion Criteria: respiratory distress; COPD requiring oxygen; primary intracranial
 hemorrhage on admission brain imaging; time from symptom onset to sleep study or CPAP
 treatment >72 hours or time from hospital admission to sleep study or CPAP treatment >48
 hours; life expectancy less than 6 months; inability to provide informed consent; inability
 to communicate in English; residence outside the greater New Haven area; or any condition
 where the monitoring required by the study would constitute a risk to the patient or impair
 his or her care.

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