Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 6
Disclosures: Heather M. Barnett, MD PhD: Nothing to disclose
Objective: To investigate if an intensive continuous positive airway pressure (CPAP) adherence protocol, implemented during inpatient rehabilitation in stroke patients with obstructive sleep apnea, could facilitate adherence to CPAP. To determine predictors of 3-month CPAP adherence following stroke, the period of maximal stroke recovery.
Design: Single-arm pilot study.
Setting: General inpatient rehabilitation units.
Participants: 90 participants with stroke admitted to inpatient rehabilitation (IPR) enrolled in study piloting an intensive CPAP adherence protocol.
Interventions: We implemented an intensive CPAP adherence protocol with a multidisciplinary team of respiratory therapists, sleep technicians, rehabilitation psychologists, and rehabilitation nurses. Obstructive sleep apnea (OSA) was assessed during a 3-night run-in with auto-titrating CPAP. Qualifying participants were offered a 3-month trial of CPAP and were provided CPAP and stroke education, iterative CPAP adjustments, and motivational interviewing during and after IPR.
Main Outcome Measures: Adherence to CPAP at 3 months (defined as use of ≥4 hours/night on ≥70% of nights); neurological and functional recovery over a 3-month period.
Results: Over the 3-month trial, 62% of the 52 patients who participated were adherent. Of the 15 aphasic patients, 14 (93.3%) were adherent to CPAP over the 3-month period compared to 18/37 (48.6%) of non-aphasic patients (RR 1.92, 95% CI 1.34-2.74, P=.003). Over the 3-month study, aphasic patients used CPAP for an average of 6.4±1.8 hours/night compared to 4.0±2.6 hours/night for non-aphasic patients. After discharge from IPR, aphasic patients increased average hours used by 3.4±43% while non-aphasic patient decreased hours used by 28±52% (P=.03). Improvement in cognitive FIM was greater among aphasic patients (13.2±5.7 vs 4.1±3.1, P=.0006) and those adherent to CPAP (8.2±6.5 vs 4.6±3.0, P=.03).
Conclusions: Stroke patients with aphasia were more likely to be adherent to CPAP, used CPAP more hours/night compared with non-aphasic patients, and remained adherent after discharge from IPR. Initiating CPAP during IPR among aphasic stroke patients may facilitate long-term use and potentially improve stroke recovery.
Level of Evidence: Level I
To cite this abstract in AMA style:Barnett HM, Billings M, Kunze A, Crane D, Khot S. Use of Continuous Positive Airway Pressure During Stroke Rehabilitation: Differences Between Aphasic and Non-aphasic Patients [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/use-of-continuous-positive-airway-pressure-during-stroke-rehabilitation-differences-between-aphasic-and-non-aphasic-patients/. Accessed September 28, 2023.
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