Magazine article Clinical Psychiatry News

CPAP May Lower Stroke Risk for Apnea Patients

Magazine article Clinical Psychiatry News

CPAP May Lower Stroke Risk for Apnea Patients

Article excerpt

SALT LAKE CITY -- Studies consistently show a link between obstructive sleep apnea and stroke, with the most recent data showing that sleep apnea is an independent risk factor for stroke and death.

The cumulative data in regard to sleep apnea and stroke suggest that patients with sleep apnea should be treated with continuous positive airway pressure (CPAP) or other measures, Dr. Vahid Mohsenin said at the annual meeting of the Associated Professional Sleep Societies.

The evidence supporting the efficacy of CPAP is overwhelming--with good compliance, efficacy is about 90%--and the expectation is that treatment will reduce the risk of stroke, although more research is needed to confirm this, said Dr. Mohsenin, professor of medicine and director of the Yale Center for Sleep Medicine, Yale University, New Haven, Conn.

In fact, a guideline from the American Heart Association/American Stroke Association Stroke Council for the primary prevention of ischemic stroke was updated earlier this year to incorporate new information about stroke prevention, including data on the role of sleep-disordered breathing in stroke. The guideline was initially published in 2001.

Although the guideline stops short of making specific treatment recommendations, and instead states that treatment should be individualized, it does address patient evaluation. It is reasonable that patients and their bed partners be questioned about symptoms of sleep-disordered breathing and that appropriate patients be referred to a sleep specialist for further evaluation, the guideline states.

This is particularly important if the patient has drug-resistant hypertension or certain risk factors for stroke, such as abdominal obesity and hypertension (Stroke 2006;37:1583-633).

In making its recommendation, the AHA/ASA Stroke Council cited data from several studies, including a case-control study of 181 patients, which showed an association between excessive daytime sleepiness (likely caused by obstructive sleep apnea) and stroke (odds ratio 3.07).

The council also cited a 10-year observational study of more than 1,600 men, which showed that those with severe obstructive sleep apnea-hypopnea had an increased risk of fatal and nonfatal cardiovascular events including stroke, compared with healthy individuals (OR 2.87 and 3.17, respectively).

The guideline noted that there are a number of biologically plausible mechanisms for a link between sleep apnea and stroke; Dr. Mohsenin agreed.

Several studies suggest that the mechanism by which sleep-disordered breathing increases stroke risk is by "leading to or worsening hypertension and heart disease and possibly by causing reductions in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, accelerated atherogenesis, hypercoagulability, inflammation, and paradoxical embolism in patients with patent foramen ovale," the guideline states. …

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