J 2021

Autotitrating Bilevel Positive Airway Pressure in Large Vessel Steno-Occlusive Stroke Patients With Suspected Sleep Apnea: A Multicenter Randomized Controlled Study

BARLINN, K., Stanislava JAKUBÍČEK, T. SIEPMANN, O. Y. CHERNYSHEV, L. P. PALLESEN et. al.

Basic information

Original name

Autotitrating Bilevel Positive Airway Pressure in Large Vessel Steno-Occlusive Stroke Patients With Suspected Sleep Apnea: A Multicenter Randomized Controlled Study

Authors

BARLINN, K. (guarantor), Stanislava JAKUBÍČEK (703 Slovakia, belonging to the institution), T. SIEPMANN, O. Y. CHERNYSHEV, L. P. PALLESEN, M. WIENECKE, W. HERMANN, X. GRAEHLERT, A. W. ALEXANDROV, M. VOSKO, V. PUETZ, H. REICHMANN, U. BODECHTEL, Robert MIKULÍK (203 Czech Republic, belonging to the institution), J. BARLINN and A. V. ALEXANDROV

Edition

FRONTIERS IN NEUROLOGY, LAUSANNE, FRONTIERS MEDIA SA, 2021, 1664-2295

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

Impact factor

Impact factor: 4.086

RIV identification code

RIV/00216224:14110/21:00121974

Organization unit

Faculty of Medicine

DOI

UT WoS

000644387900001

Keywords in English

acute ischemic stroke; sleep apnea; acute therapy; noninvasive ventilation; cerebral hemodynamics

Tags

Tags

International impact, Reviewed
Změněno: 23/7/2021 14:33, Mgr. Tereza Miškechová

Abstract

V originále

Background: We hypothesized that autotitrating bilevel positive airway pressure (auto-BPAP) favorably affects short-term clinical outcomes in hyperacute ischemic stroke. Methods: In a multicenter, randomized, controlled trial patients with large vessel steno-occlusive stroke and clinically suspected sleep apnea were allocated to auto-BPAP or standard stroke care alone. Auto-BPAP was initiated within 24 h from stroke onset and performed over 48 h during diurnal and nocturnal sleep. Sleep apnea was assessed using cardiorespiratory polygraphy. Primary endpoint was early neurological improvement on National Institutes of Health Stroke Scale (NIHSS) score at 72 h. Safety and tolerability of BPAP, functional independence [modified Rankin Scale (mRS) 0-2], stroke recurrence, and mortality at 90 days were assessed. Results: Due to low recruitment, the trial was prematurely stopped after 24 patients had been randomized (auto-BPAP, n = 14; control, n = 10): median baseline NIHSS 13 (5.5-18), 88% large vessel occlusion, and 12% large vessel stenosis. Polygraphy confirmed sleep apnea in 64% of auto-BPAP and 88% of control patients (p = 0.34). Adherence to auto-BPAP was achieved by 9 of the 14 (64%) patients. Between auto-BPAP and control patients, no differences were observed in early neurological improvement (median NIHSS change: -2.0, IQR = 7 points vs. -0.5, IQR = 3 points), 90 days functional independence (21 vs. 30%, p = 0.67), stroke recurrence (0 vs. 20%, p = 0.16), and death (14 vs. 20%, p = 1.0). No safety concerns were identified. Conclusions: In this prematurely terminated trial, auto-BPAP was safe but did not show an effect on short-term clinical outcomes in selected ischemic stroke patients. Its tolerability, however, may be limited in hyperacute stroke care and needs to be improved before larger trials are conducted.