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Short- and long-term continuous positive airway pressure usage in the post-stroke population with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) is highly prevalent in post-stroke patients and observational evidence suggests that untreated it is a harbinger of poorer outcomes in this population. Clinical trials on the impact of treatment of OSA with continuous positive airway pressure (CPAP) have countered difficulties with patient engagement and adherence to CPAP therapy. Real-world data on continuous positive airway pressure initiation and usage in the post-stroke population with obstructive sleep apnea is limited.

Methods

We performed a clinical retrospective study between January 2006 and June 2015 to describe the short- and long-term CPAP usage in the post-stroke population with OSA, and to assess which patient, disease, and treatment-related factors were associated with CPAP purchase, initiation, and usage in this population.

Results

Of 191 post-stroke patients’ recommended CPAP therapy, post-prescription usage at 3, 6, 12, 24, and 60 months was 58%, 53%, 48%, 45%, and 39% respectively. OSA severity-related factors, such as AHI or degree of nocturnal hypoxemia, were not significantly associated with CPAP usage. Predictors of CPAP usage at all time points were younger age, male sex, never smokers, and no history of hypertension. There were some differences in predictors of CPAP usage between early and later time periods.

Conclusions

We demonstrated that the long-term usage of CPAP therapy is possible with most of the attrition occurring in the first 3 months. Upfront healthcare resource allocation to CPAP initiation and usage in this population may improve longer-term usage.

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Abbreviations

AHI:

apnea-hypopnea index

BMI:

body mass index

CCI:

Charlson comorbidity index

CPAP:

continuous positive airway pressure

ESS:

Epworth sleepiness scale

IQR:

interquartile range

ODI:

oxygen desaturation index

OSA:

obstructive sleep apnea

PSG:

polysomnogram

SpO2 :

peripheral arterial oxygen saturation

UHN:

University Health Network

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Author information

Authors and Affiliations

  1. Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Tetyana Kendzerska

  2. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Kelly Wilton, Russell Bahar & Clodagh M. Ryan

  3. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

    Clodagh M. Ryan

  4. Toronto General Hospital, 9N-967, 585 University Avenue, Toronto, ON, M5G 2N2, Canada

    Clodagh M. Ryan

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  1. Tetyana Kendzerska
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  2. Kelly Wilton
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  4. Clodagh M. Ryan
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Correspondence to Clodagh M. Ryan.

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The work was performed at the University Health Network, Toronto, Canada.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kendzerska, T., Wilton, K., Bahar, R. et al. Short- and long-term continuous positive airway pressure usage in the post-stroke population with obstructive sleep apnea. Sleep Breath 23, 1233–1244 (2019). https://doi.org/10.1007/s11325-019-01811-9

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