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CPAP Lowers Mortality Risk in Stroke Patients With Obstructive Sleep Apnoea NEW YORK -- June 25, 2009 -- Stroke patients with obstructive sleep apnea (OSA) who undergo treatment with continuous positive airway pressure (CPAP) following their stroke may substantially reduce their risk of death, according to a study published in the July 1 issue of the American Journal of Respiratory and Critical Care Medicine. “Our results suggest that patients with ischaemic stroke and moderate to severe OSA showed an increased mortality risk,” wrote lead author Miguel Angel Martínez-García, MD, Requena General Hospital, Valencia, Spain. “CPAP treatment, although tolerated by only a small percentage of patients, is associated with a reduction in this excess risk and achieves a mortality similar to patients without OSA or with mild disease.” The study identified and recruited 166 consecutive patients (mean age, 73.3 years) from Requena General Hospital who had had an ischaemic stroke and subsequently were diagnosed with sleep apnoea in sleep study tests. CPAP treatment was offered to the 96 patients who scored > 20 on the apnoea-hypopnea index, indicating moderate-to-severe OSA. Each patient was followed for 5 years, reporting to the outpatient clinic and 1, 3, and 6 months, then at 6 month intervals until the conclusion of the study. They were evaluated for general status, new cardiovascular events, CPAP adherence, and death. At the conclusion of the 5-year follow-up period, nearly half (48.8%) of the original study group had died and only 28 of the original 96 were considered to be fully compliant with CPAP treatment. After adjusting for 13 potentially confounding variables, including age, gender, co-morbidities, and current smoking, the researchers found that those with moderate to severe OSA who had not complied with CPAP treatment had nearly 1.6 times the risk of death compared with patients who tolerated CPAP, whereas those with moderate-to-severe disease who had tolerated CPAP had similar risk of death than patients without sleep apnoea or mild disease. “Our results suggest that moderate to severe OSA in patients with stroke has an unfavourable effect on long-term mortality. CPAP treatment is associated with a reduction in this excess risk,” concluded Dr. Martínez-García. However, while the researchers controlled for the measurable variables they anticipated as potentially contributing to the link between CPAP compliance and risk of death following stroke, they acknowledge that certain variables were impossible to adequately anticipate or measure. “Patients who did not tolerate CPAP might have a special profile; [they] may have poor adherence to other types of treatment, including treatment of cardiovascular prevention, which would carry with it a higher risk of stroke,” said Dr. Martínez-García. “However, the variables that measure the adherence of all the treatments in these patients are very difficult to analyse because patients often take many medications. This is a limitation of our study.” SOURCE: American Thoracic Society E-mail this page to a friend or colleague! To print, use this version