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Sleep apnea affects more than half of patients with acute ischemic stroke and is associated with poor stroke outcome. This pilot study assessed the feasibility of a randomized, sham-controlled continuous positive airway pressure (CPAP) trial in subjects with acute ischemic stroke. Subjects identified with sleep apnea based on an apnea-hypopnea index ≥5 on overnight polysomnography or portable respiratory monitoring within 7 days of onset of stroke symptoms were randomized to receive active or sham CPAP for a 3-month period. Objective usage was ascertained by compliance data cards. Subjects, treating physicians, and outcome assessors were masked to intervention allocation. Among 87 subjects who provided consent, 74 were able to complete sleep apnea screening, 54 (73%) of whom had sleep apnea. Thirty-two subjects agreed to randomization. Of the 15 subjects who commenced active titration, 11 (73%) took the device home, and 8 (53%) completed the 3-month follow-up. Of the 17 subjects who commenced sham titration, 11 (65%) took the sham device home and completed the 3-month follow-up. The median cumulative usage hours over the 90 days were similar in the active group (53 hours; interquartile range, 22-173 hours) and the sham group (74 hours; interquartile range, 17-94 hours), and blinding to subject condition was successfully maintained. This first-ever randomized, sham-controlled trial of CPAP in patients with recent stroke and sleep apnea demonstrates that sham treatment can be an effective placebo.

Background: Obstructive sleep apnea is a very common condition after stroke, and it predicts poor outcomes. Unfortunately, stroke patients often do not tolerate continuous positive airway pressure. We hypothesized that a 1-piece head frame headgear would be easier and quicker to use than a traditional strap headgear. Methods: A convenience sample of ischemic stroke patients was taught to use 2 different headgear systems, a head frame and straps. Subjects were timed while putting on and taking off the 2 headgears, and they were queried about their ease of use. Results: All the 30 enrolled subjects found the head frame to be easier to apply and to remove than the straps. The patients took longer to put on (p < 0.01) and to remove (p < 0.01) the straps than the head frame. Conclusions: Headgear selection should be considered when fitting a stroke patient with a continuous positive airway pressure mask.

Background and Purpose— Sleep apnea is very common after stroke and is associated with poor outcome. Supine sleep is known to exacerbate apneas in the general sleep apnea population. We therefore investigated the pattern of sleep positions in the acute stroke period. Methods— Inpatients with acute ischemic stroke underwent full polysomnography that included continuous monitoring of sleep positions. Sleep apnea severity was measured using the apnea-hypopnea index (AHI). Stroke severity was measured by the NIH Stroke Scale (NIHSS) at the time of study enrollment by certified study personnel. Percent total sleep time spent in the supine position was calculated and compared by stroke severity based on a median split of NIHSS using a Wilcoxon rank-sum test. Results— Of the 30 patients, the median age was 67. The median AHI was 23 (IQR: 6, 47). Twenty-two patients (73%) had sleep apnea with an AHI ≥5. The vast majority of sleep time among the stroke cases was spent supine, with a median percent sleep time spent supine of 100 (IQR: 62, 100). The majority (63%) of subjects spent no time asleep in any of the nonsupine positions (prone, left, right). Median percent sleep time supine was 100 (IQR: 100, 100) in those with a higher NIHSS and 63 (IQR: 51, 100) in those with a lower NIHSS ( P Conclusions— Given the high prevalence of supine sleep identified, research into positional therapy for stroke patients with sleep apnea seems warranted.

Background Obstructive sleep apnea (OSA) is a common condition with substantial health consequences. A recent randomized trial found that playing the didgeridoo improved both subjective and objective sleep measures. We undertook a cross-sectional survey of professional orchestra players to test the hypothesis that playing a wind instrument would be associated with a lower risk of OSA. Methods An anonymous internet-based survey of professional orchestra members assessed risk of sleep apnea using the Berlin questionnaire. Multivariable logistic regression was used to test the association between playing a wind instrument and having a high risk score on the Berlin questionnaire, both unadjusted and adjusted for age, body mass index, and gender. Results A total of 1,111 orchestra members responded, including 369 (33%) wind instrument players. Wind players were more often male and had a higher body mass index than non-wind players. Of all musicians, 348 (31%) had a high risk of sleep apnea. Wind players were more likely than non-wind players to be at high risk in unadjusted analysis (Odds ratio = 1.47, 95% CI 1.13, 1.91), though this association was not significant in adjusted analysis (Odds ratio = 1.12 (0.82, 1.54)). Conclusion Playing a wind instrument was not associated with a lower risk of OSA.