{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:08:53Z","timestamp":1790352533538,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,8,21]]},"abstract":"\n Background<\/jats:title>\n \n Obstructive sleep apnea (\n OSA<\/jats:styled-content>\n ) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for\n OSA<\/jats:styled-content>\n among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n This randomized controlled trial among patients with ischemic stroke\/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of\n OSA<\/jats:styled-content>\n versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced),\n OSA<\/jats:styled-content>\n prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9\u00b12.1 mean hours\/nights used) and enhanced (4.3\u00b12.4\u00a0hours\/nights used;\n P<\/jats:italic>\n =0.46) patients. In intention\u2010to\u2010treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as\u2010treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no\/poor, \u22120.6\u00b12.9; some, \u22120.9\u00b11.4; good, \u22120.3\u00b11.0;\n P<\/jats:italic>\n =0.0064) and improved modified Rankin Scale score (no\/poor, \u22120.3\u00b11.5; some, \u22120.4\u00b11.0; good, \u22120.9\u00b11.2;\n P<\/jats:italic>\n =0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0\u20131) versus 38% of controls (\n P<\/jats:italic>\n =0.038); absolute risk reduction was 21% (number needed to treat, 4.8).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Although changes in neurological functioning and functional status were similar across the groups in the intention\u2010to\u2010treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke\/transient ischemic attack with\n OSA<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL:\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 01446913.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008841","type":"journal-article","created":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T20:16:46Z","timestamp":1536956206000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease"],"prefix":"10.1161","volume":"7","author":[{"given":"Dawn M.","family":"Bravata","sequence":"first","affiliation":[{"name":"Department of Veterans Affairs (VA) Health Services Research and Development (HSRD) Service Center for Health Information and Communication Indianapolis IN"},{"name":"Richard L. Roudebush Department of Veterans Affairs Medical Center Indianapolis IN"},{"name":"Department of Internal Medicine Indiana University School of Medicine Indianapolis IN"},{"name":"Department of Neurology Indiana University School of Medicine Indianapolis IN"},{"name":"Regenstrief Institute Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Sico","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Connecticut Healthcare System West Haven CT"},{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"},{"name":"Department of Neurology and Center for Neuroepidemiology and Clinical Neurological Research Yale School of Medicine New Haven CT"},{"name":"Clinical Epidemiology Research Center Department of Veterans Affairs Connecticut Healthcare System West Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Vaz Fragoso","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Connecticut Healthcare System West Haven CT"},{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"},{"name":"Clinical Epidemiology Research Center Department of Veterans Affairs Connecticut Healthcare System West Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"Miech","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA) Health Services Research and Development (HSRD) Service Center for Health Information and Communication Indianapolis IN"},{"name":"Richard L. Roudebush Department of Veterans Affairs Medical Center Indianapolis IN"},{"name":"Department of Internal Medicine Indiana University School of Medicine Indianapolis IN"},{"name":"Regenstrief Institute Indianapolis IN"},{"name":"Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne S.","family":"Matthias","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA) Health Services Research and Development (HSRD) Service Center for Health Information and Communication Indianapolis IN"},{"name":"Richard L. Roudebush Department of Veterans Affairs Medical Center Indianapolis IN"},{"name":"Department of Neurology Indiana University School of Medicine Indianapolis IN"},{"name":"Regenstrief Institute Indianapolis IN"},{"name":"Department of Communication Studies Indiana University\u2013Purdue University at Indianapolis (IUPUI) IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Lampert","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda S.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA) Health Services Research and Development (HSRD) Service Center for Health Information and Communication Indianapolis IN"},{"name":"Richard L. Roudebush Department of Veterans Affairs Medical Center Indianapolis IN"},{"name":"Department of Neurology Indiana University School of Medicine Indianapolis IN"},{"name":"Regenstrief Institute Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Concato","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Connecticut Healthcare System West Haven CT"},{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"},{"name":"Clinical Epidemiology Research Center Department of Veterans Affairs Connecticut Healthcare System West Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina S.","family":"Ivan","sequence":"additional","affiliation":[{"name":"Department of Neurology Indiana University School of Medicine Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. D.","family":"Fleck","sequence":"additional","affiliation":[{"name":"Department of Neurology Indiana University School of Medicine Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Tobias","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA) Health Services Research and Development (HSRD) Service Center for Health Information and Communication Indianapolis IN"},{"name":"Richard L. Roudebush Department of Veterans Affairs Medical Center Indianapolis IN"},{"name":"Department of Internal Medicine Indiana University School of Medicine Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA) Health Services Research and Development (HSRD) Service Center for Health Information and Communication Indianapolis IN"},{"name":"Richard L. Roudebush Department of Veterans Affairs Medical Center Indianapolis IN"},{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"},{"name":"Clinical Epidemiology Research Center Department of Veterans Affairs Connecticut Healthcare System West Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne","family":"Iannone","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"},{"name":"Clinical Epidemiology Research Center Department of Veterans Affairs Connecticut Healthcare System West Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Ofner","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Indiana University School of Medicine,IUPUI Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Indiana University School of Medicine,IUPUI Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Qin","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation Yale University Yale\u2013New Haven Hospital New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Won","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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