Evaluation of an OSA risk stratifying and treatment protocol during inpatient rehabilitation of post-stroke patients
- PDF / 1,319,573 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 40 Downloads / 189 Views
SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Evaluation of an OSA risk stratifying and treatment protocol during inpatient rehabilitation of post-stroke patients Zachary McKee 1 & Richard D. Wilson 2 & Dennis H. Auckley 3 Received: 25 February 2019 / Revised: 4 June 2019 / Accepted: 27 June 2019 # Springer Nature Switzerland AG 2019
Abstract Purpose To evaluate outcomes, outside of a clinical trial setting, of a protocol utilizing overnight oximetry (NOx) to risk stratify post-stroke patients for obstructive sleep apnea (OSA) followed by autoadjusting continuous positive airway pressure (APAP) treatment in patients considered high risk for OSA. Methods Retrospective observational study of post-stroke patients at an academic inpatient stroke rehabilitation facility. Patients underwent NOx, and those at high risk for OSA (oxygen desaturation index 3% > 10 per hour) were attempted on a trial of APAP, and further stratified into high risk adherent with treatment (HRAT) or high-risk failed treatment (HRFT). Change in functional independence measure (FIM) was used to assess recovery. Results Two hundred twenty-four post-stroke patients underwent NOx, with 120 (53%) considered high risk for OSA. Twelve (10%) were compliant with APAP treatment (> 4 h/night on > 70% of nights). No difference in change in FIM scores was observed for HRAT versus HRFT [total FIM change − 5.8, 95% CI (− 13.9, 2.2); motor FIM change − 4.5, 95% CI (− 11.5, 2.4); cognitive FIM change − 1.3, 95% CI (−3.8, 1.2)]. A subgroup analysis matched 14 HRAT patients (using adherence criterion of APAP usage > 50% of nights) to 35 HRFT patients. A statistically significant, but clinically irrelevant, difference in total FIM change was observed (HRAT vs HRFT, difference between means − 5.2, p = 0.03). Conclusions The use of APAP in high-risk patients was poorly tolerated and did not improve post-stroke recovery. Further studies with larger sample sizes are needed to determine the effect of APAP treatment on short-term recovery. Keywords Post-stroke obstructive sleep apnea . Obstructive sleep apnea . Stroke . Overnight oximetry . Autoadjusting continuous positive airway pressure . Functional independence measure
Introduction This article does not report on a clinical trial. All authors have seen and approved the manuscript. * Dennis H. Auckley [email protected] Richard D. Wilson [email protected] 1
Case Western Reserve University School of Medicine, Cleveland, OH, USA
2
MetroHealth Rehabilitation Institute, Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
3
Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr, Cleveland, OH 44109, USA
The prevalence of obstructive sleep apnea (OSA) is reported as 5–14% of the general population, though it may vary from 2 to 38% depending on the population studied and criteria used to define OSA [1–10]. Most patients with OSA ar
Data Loading...
