Sleep for Stroke Management And Recovery Trial (Sleep SMART)

治疗阻塞性睡眠呼吸暂停(OSA)以预防和恢复中风是一个难得的机会 对中风后护理和预后产生变革性影响。OSA在中风后非常普遍(~75%) 并且是已知的功能预后不良、死亡率和复发中风的危险因素。此外，OSA是 通过一种安全、简单、成本相对较低的治疗方法--持续气道正压治疗(CPAP)，可以很容易地进行治疗。 观察性研究已经证明，使用CPAP的患者中风结果更好。 多项飞行员试验已经暗示了中风后CPAP的好处。这些研究为以下工作奠定了基础 一项关于CPAP在卒中后管理中作用的明确试验。这一关键的下一步的迫切需要是 在最新的美国中风协会二级中风预防指南中强调了这一点。因此， 研究人员现在提出了第三阶段，开放标签，盲目终点评估，多中心，随机， 确定(1)急性缺血性卒中后应用CPAP治疗阻塞性睡眠呼吸暂停综合征或高危OSA的对照试验 短暂性脑缺血发作(TIA)有助于预防中风复发、急性冠脉综合征和各种原因 事件发生后6个月的死亡率，以及(2)急性缺血性卒中后不久是否接受OSA治疗 改善3个月后的中风预后。这项研究利用了一种高效且节省成本的设计，包括 为期6个月的预防试验和嵌入3个月的恢复试验。多年的试点工作已经确定 挑战与卒中后阻塞性睡眠呼吸暂停的诊断和治疗有关。这些有价值的见解结合在一起- 凭借创新的数字和生物医学技术，为这项高度务实的试验做出了贡献 可行性是最重要的。特别是，由于多导睡眠图和CPAP滴定很少在 急性中风，OSA将通过使用便携式心肺睡眠呼吸暂停测试来确定，并进行治疗 带有自动调节CPAP的装置。通过最先进的方法，受试者将收到 对CPAP使用情况进行集中、实时、夜间监控并进行主动护理管理，以最大限度地提高CPAP 坚持不懈。这一方法简化了阻塞性睡眠呼吸暂停综合征的诊断和治疗，这将有助于 在资源匮乏的医院实施。因此，这一试验为StrokeNet提供了一个机会 更充分地利用其网络，并将使积极的试验结果容易地转化为社区 这项研究代表着一个难得的机会来改变中风后的护理 以安全、成本效益高的干预方式，在很大程度上改善恢复和预防 患者比例。

Treatment of obstructive sleep apnea (OSA) for stroke prevention and recovery represents a rare chance to achieve transformative impact on post-stroke care and outcomes. OSA is highly prevalent after stroke (~75%) and is a known risk factor for poor functional outcome, mortality, and recurrent stroke. Furthermore, OSA is readily treated by a safe, simple, and relatively low-cost therapy, continuous positive airway pressure (CPAP). Observational studies have already demonstrated better stroke outcomes among patients who use CPAP, and multiple pilot trials have hinted at the benefits of CPAP after stroke. These studies have laid the foundation for a definitive trial on the role of CPAP in post-stroke management. The pressing need for this critical next step is highlighted in the latest American Stroke Association secondary stroke prevention guidelines. Therefore, the investigators now propose a phase III, open-label, blinded-endpoint assessment, multicenter, randomized, controlled trial to determine (1) whether treatment of OSA with CPAP after acute ischemic stroke or high-risk transient ischemic attack (TIA) helps to prevent recurrent stroke, acute coronary syndrome, and all-cause mortality 6 months after the event, and (2) whether treatment of OSA shortly after acute ischemic stroke improves stroke outcomes at 3 months. This study capitalizes on an efficient and cost-saving design involving a 6-month prevention trial with an embedded 3-month recovery trial. Many years of pilot work have identified the challenges related to the diagnosis and treatment of OSA after stroke. These valuable insights - combined with innovative digital and biomedical technology - have contributed to this highly pragmatic trial in which feasibility is paramount. In particular, as polysomnography and CPAP titration are seldom tolerated just after acute stroke, OSA will be identified through use of a portable cardiopulmonary sleep apnea test, and treated with an automatically adjusting CPAP device. Through state-of-the-art methods, subjects will receive centralized, real-time, nightly monitoring of CPAP use and proactive care management to maximize CPAP adherence. This approach simplifies and streamlines the diagnosis and treatment of OSA, which will facilitate implementation in hospitals with low resources. Consequently, this trial provides StrokeNet with an opportunity to use its network more fully, and will permit positive trial results to be readily translated into community settings across the U.S. This study represents a rare opportunity to change post-stroke care in a fundamental manner with a safe, cost-effective intervention that could improve both recovery and prevention in a substantial proportion of patients.