Effect of Continuous Positive Airway Pressure (CPAP) on Cognitive and Functional Performance in Stroke Patients With Obstructive Sleep Apnea
Condition: Sleep Apnea, Obstructive; Cerebrovascular Accident
MeSH terms: Apnea; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Stroke
Study type: Interventional
Phase: Phase 3

Summary: 
      " Obstructive sleep apnea"(OSA) is a sleep breathing disorder. When a person with OSA tries
      to sleep the back of the throat closes and blocks the flow of air into lungs.When this
      happens, a person's sleep is disrupted, causing minor awakenings(which the individual may not
      recognize). This occurs many times throughout the night, causing poor sleep quality,excessive
      daytime sleepiness, poor concentration, and sometimes depression.It is possible that poor
      outcomes observed in stroke patients with OSA result from these neurocognitive phenomena,
      presumably by reducing effective participation in rehabilitation activities.OSA is treated
      with nasal continuous positive airway pressure(CPAP).CPAP therapy keeps the back of the
      throat open so that airflow is never blocked.The study is designed to investigate whether
      treatment of OSA with CPAP improves the results of rehabilitation.
    

Detailed description: 
      Stroke occurs as a result of ischemic injury to neural tissue, as a result of cardiogenic or
      artery to artery embolism or intracranial arterial thrombosis. The traditional vascular risk
      factors, namely hypertension, diabetes mellitus, tobacco smoking, family history and
      hyperlipidemia as well as atrial fibrillation are major determinants of stroke risk.
      Obstructive sleep apnea (OSA) has been shown to be a risk factor for hypertension
      and,although the association is less strong, atherosclerotic heart disease.There is a high
      prevalence of OSA amongst stroke patients, on the order of 60 to 70%, which is tenfold higher
      than in the general healthy population. Recently, it has been shown that, in stroke patients
      undergoing inpatient rehabilitation,the presence of OSA predicts both a poor functional
      outcome and greater length of hospitalization in the rehabilitation unit, even after
      adjustment for stroke severity.

      We propose to examine the effect of CPAP therapy on the neuropsychological and functional
      outcomes of stroke patients with OSA admitted to the Toronto Rehabilitation Institute Stroke
      Rehabilitation Unit in a prospective, randomized study. We hypothesize that, in stroke
      patients with OSA, CPAP therapy will improve indices of vigilance, attention, and cognitive
      performances well as motor function(as it does in OSA patients without stroke)when compared
      to those not treated with CPAP. Furthermore,we hypothesize that the outcome of
      rehabilitation, as assessed by neuropsychological and motor indices, will be improved in
      these patients.
    

Intervention name(s): Nasal Continuous positive airway pressure - Tyco 420G
Intervention type(s): Device
Intervention description(s): CPAP at determined pressure nightly for 1 month
Other intervention name(s): Tyco CPAP machines 420 G
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Sleep Apnea Syndromes; Cerebrovascular Accident