Please select the eligibility criteria that correspond to the clinical trial below.
Title: Usefulness of Nasal CPAP Treatment in Patients With a First Ever Stroke and Sleep Apnea Syndrome
Brief Summary: MAIN AIMS: to analyze the efficacy of nasal CPAP treatment in patients with ischemic first-ever stroke and Sleep Apnea Syndrome (SAS) in terms of: early neurological outcome, functional recovery, quality of life influence, stroke recurrence and survival.

SECONDARY AIMS: to evaluate the feasibility of the treatment in this type of patients at short and long time.

DESIGN: clinical randomized case-control study.

PATIENTS: younger than 75 years with a First-Ever stroke with at least one of the following criteria: snoring, observed apnea, Hypertension or Ischemic Cardiopathy.

MEASUREMENTS: protocol to define subtype stroke and parenchymatous and vascular location; sleep questionnaire (including Epworth Sleepiness Scale); Respiratory Polysomnography (RPSG). If RPSG shows an AHI \> 20, with predominant obstructive events, patients will be randomized in a CONTROL GROUP (conventional treatment) and a TREATMENT GROUP (with Nasal CPAP). Follow up for both groups at 1, 3, 12 and 24 months will include: early neurological outcome, body mass index (BMI), blood pressure (BP), functional recovery (Barthel Index/Canadian Scale), quality of life (SF36), recurrences, vital status. Nasal CPAP titration will be performed by means of an automatic system (Autoset Portable ST). Compliance will be recorded. If a negative RPSG is obtained (AHI \< 10) (NO SAS GROUP) or with AHI \< 20 (mild SAS) the usual treatment and the same follow up protocol will be established.

STATISTICS: the sample size is initially calculated in 10 patients for each group, considering this is part of a multicenter study including 8 centers. If no differences are found, depending on the statistical power the investigators will consider including more patients. The different groups will be compared for the analyzed variables with the corresponding tests.


Options:
A: Inclusion Criteria:

* 18 years and older.
* Ability to speak, read and write Dutch.
* Ability to follow up.
* Ability to use a computer with internet connection and windows-software for uploading data and online questionnaires.
* Diagnosis with symptomatic mild or moderate OSA (5 \< AHI \< 30).
* Diagnosis of 10 to 90% supine position during the night.
* AHI supine is \>2 times as high as AHI non-supine.
* Expected to maintain current lifestyle (sports, medicine, diet etc.).

Exclusion Criteria:

* Many dental problems; insufficient teeth for wearing OAT.
* Medication used/ related to sleeping disorders.
* Central Sleep Apnoea Syndrome.
* Night or shifting work.
* Severe chronic heart failure.
* Medical history of known causes of tiredness by day or severe sleep disruption (insomnia, PLMS, Narcolepsy).
* Seizure disorder.
* Known medical history of mental retardation, memory disorders or psychiatric disorders.
* Patients with old type of pacemakers (It is possible that old types of peacemakers are not compatible with the electromagnetic radiation of the electronics of the SPT).
* Shoulder, neck and back complaints.
* Reversible morphological upper airway abnormalities (e.g. enlarged tonsils).
* Inability to provide informed consent.
* Simultaneous use of other treatment modalities to treat OSA.
* Previous treatment for OSA with OAT or SPT
* Pregnancy.
B: Inclusion Criteria:

* patients with supine dependent Obstructive Sleep Apnea (OSA) after Mandibular Advancement Device (MAD) Therapy: Apnea Hypopnea Index (AHI) supine ≥ 2x AHI non supine
* 5 \< AHI \< 50/h sleep on polysomnography (PSG) with MAD in situ
* ≥ 20% supine position during PSG with the MAD in situ
* AHI non-supine \< 10/h en AHI supine ≥ 10/h on PSG with MAD in situ
* Unchanged Body Mass Index (BMI)(BMI ± 1 kg/m²) at moment of inclusion compared to BMI at baseline PSG

Exclusion Criteria:

* age \< 18 years
C: Inclusion Criteria:

1. Postpartum mothers within 48 hours of delivery in a major academic teaching hospital.
2. Age over 18 years.
3. Admitted to the Massachusetts General Hospital OB service for the delivery.
4. Interventions will be randomly assigned to the patients enrolled in this study

Exclusion Criteria:

1. Age under 18 years.
2. History of pre-existing pulmonary and cardiac diseases, including bronchial asthma, cystic fibrosis, chronic obstructive lung disease, neck and chest tumors (thyroid, mediastinal, etc.), irradiation to the neck and/or chest, and congenital airway deformities, other critically-ill conditions.
D: Inclusion Criteria:

* First ever stroke
* Any Sleep Apnea symptom
* Hypertension

Exclusion Criteria:

* Aphasia
* Cognitive impairment
* Hypersomnolence

Answer: D