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Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack: a randomized feasibility trial

机译:急性短暂性脑缺血发作患者自动调整持续气道正压:一项随机可行性试验

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摘要

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 >or=4 hours per night for >or=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.
机译:背景与目的:短暂性脑缺血发作(TIA)患者处于复发性血管事件的风险中。主要目标是评估TIA患者中睡眠呼吸暂停的患病率,以及在睡眠呼吸暂停患者中自动滴定持续气道正压通气(auto-CPAP)依从性。次要目的是通过自动CPAP使用类别描述TIA睡眠呼吸暂停患者的复发性血管事件发生率。方法:所有干预患者均接受自动CPAP 2晚,但只有有睡眠呼吸暂停迹象的干预患者接受自动CPAP在90天的剩余时间内。 TIA后90天,干预患者接受了多导睡眠监测。对照患者在基线和90天时接受了多导睡眠监测。可接受的自动CPAP依从性被定义为每晚>或= 4小时,占晚上的>或= 75%。血管事件包括反复发作的TIA,中风,因充血性心力衰竭住院,心肌梗塞或死亡。结果:我们招募了70例急性TIA患者:45例干预和25例对照。大多数患者有睡眠呼吸暂停:基线时为57%,90天时为59%。在30例有气流阻塞的干预患者中,有12例(40%)接受了可接受的自动CPAP依从性,18例(60%)进行了一些使用,没有人没有使用。三例干预患者(12%)有复发事件,而对照组为1例(2%; P = 0.13)。没有使用CPAP的睡眠呼吸暂停患者中,血管事件发生率最高:无,16%;有的,5%;可接受的依从性为0%(P = 0.08)。结论:急性TIA患者睡眠呼吸暂停是常见的。在急性TIA期间提供自动CPAP似乎是可行的。较大的研究应评估诊断和治疗睡眠呼吸暂停的策略是否可以减少TIA后复发的血管事件。

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