Toronto Rehabilitation Institute, University of Toronto, Ontario, Canada.
Stroke. 2011 Apr;42(4):1062-7. doi: 10.1161/STROKEAHA.110.597468. Epub 2011 Mar 3.
In stroke patients, obstructive sleep apnea (OSA) is associated with poorer functional outcomes than in those without OSA. We hypothesized that treatment of OSA by continuous positive airway pressure (CPAP) in stroke patients would enhance motor, functional, and neurocognitive recovery.
This was a randomized, open label, parallel group trial with blind assessment of outcomes performed in stroke patients with OSA in a stroke rehabilitation unit. Patients were assigned to standard rehabilitation alone (control group) or to CPAP (CPAP group). The primary outcomes were the Canadian Neurological scale, the 6-minute walk test distance, sustained attention response test, and the digit or spatial span-backward. Secondary outcomes included Epworth Sleepiness scale, Stanford Sleepiness scale, Functional Independence measure, Chedoke McMaster Stroke assessment, neurocognitive function, and Beck depression inventory. Tests were performed at baseline and 1 month later.
Patients assigned to CPAP (n=22) experienced no adverse events. Regarding primary outcomes, compared to the control group (n=22), the CPAP group experienced improvement in stroke-related impairment (Canadian Neurological scale score, P<0.001) but not in 6-minute walk test distance, sustained attention response test, or digit or spatial span-backward. Regarding secondary outcomes, the CPAP group experienced improvements in the Epworth Sleepiness scale (P<0.001), motor component of the Functional Independence measure (P=0.05), Chedoke-McMaster Stroke assessment of upper and lower limb motor recovery test of the leg (P=0.001), and the affective component of depression (P=0.006), but not neurocognitive function.
Treatment of OSA by CPAP in stroke patients undergoing rehabilitation improved functional and motor, but not neurocognitive outcomes.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00221065.
在脑卒中患者中，阻塞性睡眠呼吸暂停（OSA）与较差的功能结局相关，而非 OSA 患者则不然。我们假设通过持续气道正压通气（CPAP）治疗 OSA 会增强脑卒中患者的运动、功能和神经认知恢复。
这是一项在脑卒中康复病房中进行的、针对 OSA 脑卒中患者的、随机、开放标签、平行组试验，采用盲法评估结局。患者被随机分配至标准康复治疗（对照组）或 CPAP（CPAP 组）。主要结局为加拿大神经学量表、6 分钟步行测试距离、持续注意力反应测试和数字或空间广度测试。次要结局包括 Epworth 嗜睡量表、斯坦福嗜睡量表、功能独立性测量、Chedoke-McMaster 脑卒中评估、神经认知功能和贝克抑郁量表。测试于基线和 1 个月后进行。
CPAP 组（n=22）患者未发生不良事件。在主要结局方面，与对照组（n=22）相比，CPAP 组脑卒中相关损伤改善（加拿大神经学量表评分，P<0.001），但 6 分钟步行测试距离、持续注意力反应测试和数字或空间广度测试无改善。在次要结局方面，CPAP 组 Epworth 嗜睡量表（P<0.001）、功能独立性测量运动分量表（P=0.05）、Chedoke-McMaster 脑卒中评估上下肢运动恢复测试的下肢（P=0.001）和抑郁的情感成分（P=0.006）改善，而神经认知功能无改善。
在接受康复治疗的脑卒中患者中，CPAP 治疗 OSA 可改善功能和运动，但不能改善神经认知结局。
