Many stroke patients have undiagnosed cases of sleep apnea. Is CPAP therapy really the key for stroke recovery?
Obstructive sleep apnea, the most common form of sleep apnea, is characterized by repetitive closure of the upper airway during sleep. This closure results in a recurrent cycle of sleep disruption and possible hypoxia. Symptoms include loud snoring, feeling unrested when you wake up, and a general lack of energy during the day.
Diagnosing sleep apnea is based on clinical assessment and sleep studies conducted in a sleep clinic and under the observation of a sleep technician. Sleep apnea can result in poor job performance, loss of employment due to poor job performance, impaired family relationships, reduced quality of life, and an increased risk of motor vehicle crashes.
Take these symptoms and sleep apnea seriously. If you have sleep apnea, you are at an increased risk gaining excess weight, high blood pressure, heart problems, and type 2 diabetes. You may also experience metabolic syndrome, complications with medications and surgery, liver problems, and sleep-deprived partners. Strokes are known risks for sleep apnea.
Good news! A recent study treated patients who were at risk of strokes with a continuous positive airway pressure (CPAP mask) device to ease breathing difficulties.
Researchers discovered that among stroke patients, treatment of sleep apnea with CPAP therapy presented significant benefits. Gains with a CPAP device were even more significant in treating stroke than the benefits of tPA, or the drug treatment that is FDA-approved for stoke treatments.
"That's a substantial clinical effect," Dr. Dawn Bravata said. "The added good news for stroke patients is that CPAP has been used as a sleep apnea therapy for many years, and it has an excellent safety record." Bravata is a research scientist with the Regenstrief Institute and Roudebush VA Medical Center in Indianapolis.
Most stroke patients have undiagnosed sleep apnea
Sleep apnea is common for those who have had a mini-stroke or a stroke. Most stroke patients are not diagnosed or treated for sleep apnea, and researchers state that two out of three stroke patients have irregular breathing during sleep and sleep apnea symptoms. Sleep apnea leads to irregular heartbeats, low oxygen levels, and high blood pressure.
In Dr. Bravata’s study, outcomes for 252 people who had experienced a stroke or a mini-stroke (a transient ischemic attack) were observed. Patients were divided into three groups – a control group who received regular care (no sleep apnea treatment), another group received typical care plus CPAP therapy, and the third group received enhance care with CPAP therapy. Those patients who used CPAP devices for an average of 50 percent of the nights showed marked improvement in their stroke recovery.
The timing of CPAP therapy may also be necessary, according to the study authors. According to Dr. Bravata, the sooner sleep apnea is treated in stroke victims, the better their recovery from strokes will be.
Dr. Bravata goes on to explain that diagnosing sleep apnea is usually an outpatient service. She feels that it is necessary to make sleep apnea treating available to stroke and TIA patients in the hospital as part of examinations. Stroke victims undergo lab testing, brain imaging, and cardiac monitoring as part of their stroke/TIA evaluations. Sleep apnea testing needs to be included in initial evaluations.
Dr. Andrew Rogrove, director of stroke services at Northwell Health’s Southside Hospital in Bay Shore, New York says, "This study is fascinating -- it shows that a simple intervention, treating obstructive sleep apnea, can improve outcomes in stroke patients.”
Dr. Rogrove emphasizes that it would be essential to assess recovery rates when CPAP devices are used more often than the 50 percent of nights observed in the original study.
Another expert in stroke care, Dr. Salma Azhar director of stroke care at Lenox Hill Hospital in New York City, noted that there had been several studies showing sleep apnea as a factor in stroke recovery. Testing for sleep apnea could help make those outcomes better.
As reported in the Journal of the American Heart Association, Dr. Azhar stated, "With the current ease of doing home sleep studies, the diagnosis of obstructive sleep apnea has become much simpler and should be considered in all stroke patients with positive screening questionnaire results.”
Using CPAP treatment might be key to stroke recovery
Treating sleep apnea positively impacts your life and increases energy, alertness during the day and contributes to a healthier happier life.
There will be discomfort, and you will feel a bit uncomfortable at first but using a CPAP machine doesn’t have to be a deal-breaker. Once you know what to do, your CPAP machine can become your best nighttime friend.
Sairam Parthasarathy, MD, medical director of the Center for Sleep Disorders at the University of Arizona calls using a CPAP machine like wearing a new pair of shoes: “They’re initially going to chafe or hurt you. Or a new pair of glasses -- you become very conscious of them. But after a while, it becomes second nature. You put it on without thinking.”
There are several types of sleep apnea therapy, but a CPAP or continuous positive airway pressure device is the most common. CPAP machines used to be clunky and noisy, and the airflow they sent into your airway was challenging to use. Now, CPAP machines send a continual flow of air pressure to your airway to keep your airways open during sleep and they do it quietly and efficiently.
CPAP therapy consists of a machine that sends airflow through a tube to a face mask. The mask keeps your airway open during sleep. It might be difficult at first to adapt to your sleep therapy device, but it will save your life.
There are a variety of masks that help you breathe during sleep. Some cover just your nose or your entire face. The type of mask you use depends on how you breathe during the night. Pads make the mask snug and form a seal so air from the therapy machine does not allow air to escape. Headgear helps to keep the mask stable as you sleep. Beware of over-tightening your headgear. Overtightening can damage your equipment and lessen the effectiveness of the CPAP treatment.
CPAP therapy machines are compact and have several different components. CPAP machines have different settings that allow you or your doctor to adjust the air pressure. Use the setting your doctor or the CPAP expert specifies. There are filters on the device. These filters make sure that you are breathing clean air. Some machines include only one filter and other machines include an additional filter to keep the air you breathe fresh and pure.
The hose attached to your mask and the CPAP device can become your best friend. Treat it kindly by not let it kink, get dirty, or get pinched.
CPAP effectively treats the spontaneous pauses in breathing associated with sleep apnea. These pauses in breathing can cause neurological symptoms like numbness and tingling and lead to a stroke. By using CPAP therapy when you have sleep apnea, you cut down your chances of a stroke and other serious diseases. CPAP therapy keeps oxygen flowing into your lungs, bloodstream, and brain while you sleep. You cut down your risk of strokes by almost 30 percent by using CPAP therapy. Discuss sleep apnea therapy if you are at risk of a stroke or recovering from a recent stroke.