Diagnosis and Treatment of Sleep Apnea in Cerebrovascular Disease

Study Overview
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Brief Summary
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Sleep apnea is common among Veterans with cerebrovascular disease (stroke or transient ischemic attack [TIA]), leads to hypertension, and is associated with recurrent stroke and death. Although continuous positive airway pressure (CPAP) safely treats sleep apnea, few Veterans with cerebrovascular disease are diagnosed with sleep apnea or offered treatment.

Detailed Description
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The project sought to evaluate whether a diagnostic and therapeutic intervention strategy among Veterans with cerebrovascular disease and hypertension using unattended polysomnography and auto-titrating CPAP with a targeted adherence evaluation and educational protocol resulted in: an improved rate of diagnosed sleep apnea, an improved rate of treated sleep apnea, and improved blood pressure control.

Official Title
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Diagnosis and Treatment of Sleep Apnea in Cerebrovascular Disease

Conditions
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Stroke, Obstructive Sleep Apnea, Transient Ischemic Attack, Hypertension

Intervention / Treatment
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* Procedure: CPAP Therapy for Newly Diagnosed Obstructive Sleep Apnea (OSA)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stroke or Transient Ischemic Attack Hypertension Exclusion Criteria: Prior diagnosis of sleep apnea or other sleep disorder Life expectancy < 6 months or Hospice Non-English speaker Unable/unwilling to use mask Inability to give informed consent Oxygen dependent COPD Chronic renal failure with dialysis Active Suicidal Ideation

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>The intervention group received unattended polysomnography and auto-titrating CPAP if sleep apnea was diagnosed | Procedure: CPAP Therapy for Newly Diagnosed Obstructive Sleep Apnea (OSA)<br>* Continuous Positive Airway Pressure (CPAP) is provided for those patients who are diagnosed with OSA.<br>|
| Other: Control<br>The control group received usual clinical care which may include receipt of sleep diagnostic and therapeutic services | Procedure: CPAP Therapy for Newly Diagnosed Obstructive Sleep Apnea (OSA)<br>* Continuous Positive Airway Pressure (CPAP) is provided for those patients who are diagnosed with OSA.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sleep Apnea Diagnosis Rate | The number of patients with a diagnosis of sleep apnea | The entire study period (baseline and up to one-year) | 
| Hypertension Control | Medication-Adjusted Systolic Blood Pressure | One year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sleep Apnea Treatment Rate |  | One year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sleep apnea, hypertension, brain ischemia