Auto-Titrating Continuous Positive Airway Pressure for Patients With Acute Transient Ischemic Attack A Randomized Feasibility Trial
Auto-Titrating Continuous Positive Airway Pressure for Patients With Acute Transient Ischemic Attack A Randomized Feasibility Trial
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DOI：
10.1161/strokeaha.109.566745
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发表时间：
2010-07-01
期刊：
影响因子：
8.3
通讯作者：
Yaggi, H. Klar
中科院分区：
文献类型：
--
作者：
Bravata, Dawn M.;Concato, John;Yaggi, H. Klar
背景和目的：短暂性脑缺血发作（TIA）患者有血管事件复发的风险。主要目的是评估TIA患者中睡眠呼吸暂停的患病率和睡眠呼吸暂停自动滴定持续气道正压通气（auto-CPAP）依从性的患者。第二个目标是描述TIA患者睡眠呼吸暂停自动CPAP使用category.Methods-All干预患者接受自动CPAP治疗2晚，但只有干预患者的睡眠呼吸暂停的证据，自动CPAP治疗的90天期间的剩余时间内的复发血管事件率。干预组患者在TIA后90天接受多导睡眠图检查。对照组患者在基线和90天时接受多导睡眠图检查。可接受的auto-CPAP依从性定义为>= 75%的夜晚每晚>= 4小时。血管事件包括TIA复发、中风、因充血性心力衰竭住院、心肌梗死或死亡。结果我们纳入了70例急性TIA患者：45例干预组和25例对照组。大多数患者患有睡眠呼吸暂停：基线时为57%，90天时为59%。在30例气流阻塞的干预患者中，12例（40%）有可接受的自动CPAP依从性，18例（60%）有一定的使用，无一例无效。3名干预患者（12%）出现复发事件，而对照患者为1名（2%; P=0.13）。未使用CPAP用途：的睡眠呼吸暂停患者血管事件发生率最高：无，16%;部分，5%;可接受的依从性0%（P=0.08）。在急性TIA期间提供自动CPAP似乎是可行的。更大规模的研究应该评估诊断和治疗睡眠呼吸暂停的策略是否可以减少TIA后血管事件的复发。（中风。2010;41：1464-1470）。
Background and Purpose-Transient ischemic attack (TIA) patients are at risk of recurrent vascular events. The primary objectives were to evaluate among TIA patients the prevalence of sleep apnea and among patients with sleep apnea auto-titrating continuous positive airway pressure (auto-CPAP) adherence. The secondary objective was to describe among TIA patients with sleep apnea the recurrent vascular event rate by auto-CPAP use category.Methods-All intervention patients received auto-CPAP for 2 nights, but only intervention patients with evidence of sleep apnea received auto-CPAP for the remainder of the 90-day period. Intervention patients received polysomnography at 90 days after TIA. Control patients received polysomnography at baseline and at 90 days. Acceptable auto-CPAP adherence was defined as >= 4 hours per night for >= 75% of nights. Vascular events included recurrent TIA, stroke, hospitalization for congestive heart failure, myocardial infarction, or death.Results-We enrolled 70 acute TIA patients: 45 intervention and 25 control. The majority of patients had sleep apnea: 57% at baseline and 59% at 90 days. Among the 30 intervention patients with airflow obstruction, 12 (40%) had acceptable auto-CPAP adherence, 18 (60%) had some use, and none had no use. Three intervention patients (12%) had recurrent events compared with 1 (2%; P=0.13) control patient. The vascular event rate was highest among sleep apnea patients with no CPAP use: none, 16%; some, 5%; acceptable adherence 0% (P=0.08).Conclusions-Sleep apnea is common among acute TIA patients. It appears feasible to provide auto-CPAP in the acute TIA period. Larger studies should evaluate whether a strategy of diagnosing and treating sleep apnea can reduce recurrent vascular events after TIA. (Stroke. 2010;41:1464-1470.)