***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Accurate outcome prediction following stroke is important for proper delivery of poststroke care . It has been difficult to determine specific factors that provide reliable and accurate predictions of outcome , particularly for patients with intermediate deficit severities . Age and severity of deficit have repeatedly been found to be most reliable , but only as rough estimates and for patients at either extreme of the disability spectrum . This paper reports a prospect i ve study of consecutive rehabilitation admissions ( N = 536 ) to determine the influence of preselected factors . Outcome was analyzed in terms of functional improvement and disposition .  Patients younger than 55 years or with an admission Functional Independence Measure ( FIM ) greater than 80 almost universally went home . Admission FIMs less than 40 were associated with nearly certain nursing home discharge . The comprehensive FIM score was a stronger predictor of outcome than motor impairment in isolation . An admission FIM of 60 or greater was associated with a higher probability of functional improvement during rehabilitation . Small-vessel strokes had the best outcome . Intracerebral hemorrhages improved more than ischemic strokes but more slowly . Right hemisphere lesions did worse than left . Comorbidities influenced outcome only when several conditions accumulated . The absence of a committed caregiver at home increased the risk of nursing home discharge . Suggestions for rehabilitation triage are given . NEUROLOGY 1996;47 : 388 - During much of sleep , cortical neurons undergo near-synchronous slow oscillation cycles in membrane potential , which give rise to the largest spontaneous waves observed in the normal electroencephalogram ( EEG ) . Slow oscillations underlie characteristic features of the sleep EEG , such as slow waves and spindles . Here we show that , in sleeping subjects , slow waves and spindles can be triggered noninvasively and reliably by transcranial magnetic stimulation ( TMS ) . With appropriate stimulation parameters , each TMS pulse at < 1 Hz evokes an individual , high-amplitude slow wave that originates under the coil and spreads over the cortex . TMS triggering of slow waves reveals intrinsic bistability in thalamocortical networks during non-rapid eye movement sleep . Moreover , evoked slow waves lead to a deepening of sleep and to an increase in EEG slow-wave activity ( 0.5–4.5 Hz ) , which is thought to play a role in brain restoration and memory consolidation Learning of a procedural motor-skill task is known to progress through a series of unique memory stages . Performance initially improves during training , and continues to improve , without further rehearsal , across subsequent periods of sleep . Here , we investigate how this delayed sleep-dependent learning is affected when the task characteristics are varied across several degrees of difficulty , and whether this improvement differentially enhances individual transitions of the motor-sequence pattern being learned . We report that subjects show similar overnight improvements in speed whether learning a five-element unimanual sequence ( 17.7 % improvement ) , a nine-element unimanual sequence ( 20.2 % ) , or a five-element bimanual sequence ( 17.5 % ) , but show markedly increased overnight improvement ( 28.9 % ) with a nine-element bimanual sequence . In addition , individual transitions within the motor-sequence pattern that appeared most difficult at the end of training showed a significant 17.8 % increase in speed overnight , whereas those transitions that were performed most rapidly at the end of training showed only a non-significant 1.4 % improvement . Together , these findings suggest that the sleep-dependent learning process selectively provides maximum benefit to motor-skill procedures that proved to be most difficult prior to sleep Background and Purpose — In stroke patients , obstructive sleep apnea ( OSA ) is associated with poorer functional outcomes than in those without OSA . We hypothesized that treatment of OSA by continuous positive airway pressure ( CPAP ) in stroke patients would enhance motor , functional , and neurocognitive recovery . Methods — This was a r and omized , open label , parallel group trial with blind assessment of outcomes performed in stroke patients with OSA in a stroke rehabilitation unit . Patients were assigned to  st and ard rehabilitation alone ( control group ) or to CPAP ( CPAP group ) . The primary outcomes were the Canadian Neurological scale , the 6-minute walk test distance , sustained attention response test , and the digit or spatial span-backward . Secondary outcomes included Epworth Sleepiness scale , Stanford Sleepiness scale , Functional Independence measure , Chedoke McMaster Stroke assessment , neurocognitive function , and Beck depression inventory . Tests were performed at baseline and 1 month later . Results — Patients assigned to CPAP ( n=22 ) experienced no adverse events . Regarding primary outcomes , compared to the control group ( n=22 ) , the CPAP group experienced improvement in stroke-related impairment ( Canadian Neurological scale score , P<0.001 ) but not in 6-minute walk test distance , sustained attention response test , or digit or spatial span-backward . Regarding secondary outcomes , the CPAP group experienced improvements in the Epworth Sleepiness scale ( P<0.001 ) , motor component of the Functional Independence measure ( P=0.05 ) , Chedoke-McMaster Stroke assessment of upper and lower limb motor recovery test of the leg ( P=0.001 ) , and the affective component of depression ( P=0.006 ) , but not neurocognitive function . Conclusions — Treatment of OSA by CPAP in stroke patients undergoing rehabilitation improved functional and motor , but not neurocognitive outcomes . Clinical Trial Registration Information— URL : http://www . clinical trials.gov . Unique identifier : NCT00221065 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To investigate the difference between the clinical effects of nasotracheal suction ( NTS ) mechanical ventilation and noninvasive positive pressure ventilation ( CPAP ) treatment of cerebral ischemic stroke ( IS ) induced by sleep apnea . PATIENTS AND METHODS Fifty-three patients diagnosed with cerebral IS caused by sleep apnea from February 2013 to February 2014 were selected for this study from our hospital . After the approval of the hospital 's Ethics Committee and patients ' signed consent , the patients were r and omly divided into a test group ( n=29 cases ) and a control group ( n=24 cases ) . All patients were given conventional treatment for stroke . The control group received the noninvasive ventilator application with CPAP model . The test group was treated with nasal endotracheal suction of mechanical ventilation treatment . Using the NIHSS scale and Barthel index , we compared the status of the nervous system on admission and after seven days stroke recovery treatment of the two groups . Through the comparison of apnea-hypopnea index ( AHI ) , oxygen desaturation index ( ODI ) , LSaO2 and MSaO2 of the two groups on the seventh day , we compared the efficacy of the obstructive sleep apnea-hypopnea syndrome ( OSAHS ) . RESULTS The NIHSS score and Barthel index score of mild , moderate and severe were compared on the OSAHS patients at admission , and the difference was not statistically significant ( p > 0.05 ) . After treatment , all patients showed lower NIHSS score and increased Barthel scores , and the difference had statistical significance ( p < 0.05 ) . For the mild OSAHS patients , we compared the NIHSS score and Barthel index score of the test and control group , and the difference was not statistically significant ( p > 0.05 ) . For the moderate and severe OSAHS patients , the NIHSS score of the test group decreased significantly . However , the Barthel index scores increased significantly , and the difference had statistical significance ( p > 0.05 ) . The AHI , LSaO2 , MSaO2 , and ODI index of the two groups of patients were compared with the treatment , and the differences were not statistically significant ( p > 0.05 ) . After treatment , the AHI and the ODI index of the two groups decreased , LSaO2 and MSaO2 index increased , and AHI and ODI index of the test group decreased more than that of the control group . However , the LSaO2 and the MSaO2 index increased , and the difference had statistical significance ( p > 0.05 ) . The total effective rate of patients of the test group was higher than that of the control group , but no effectiveness and overall mortality was lower than the control group . The difference was statistically significant ( p > 0.05 ) . CONCLUSIONS Compared with noninvasive ventilator therapy , nasotracheal suction mechanical ventilation and noninvasive positive pressure ventilation treatment of cerebral IS induced by sleep apnea can naturally improve the prognosis of nervous system recovery , and improve the respiratory ventilation function . This may be a better treatment option for moderate and severe sleep apnea patients that is worthy of clinical application The prevalence of obstructive sleep apnoea ( OSA ) following stroke is high and OSA is associated with increased morbidity , mortality and poor functional outcome . Nasal continuous positive airway pressure ( nCPAP ) is the treatment of choice for OSA , but its effects in stroke patients are unknown . The effectiveness and acceptance of treatment with nCPAP in 105 stroke patients with OSA , admitted to rehabilitation was prospect ively investigated . Subjective wellbeing was measured with a visual analogue scale in 41 patients and 24-h blood pressure was determined in 16 patients before and after 10 days of treatment . Differences were compared between patients who did and did not accept treatment . There was an 80 % reduction of respiratory events with concomitant increase in oxygen saturation and improvement in sleep architecture . No serious side-effects were noticed . Seventy-four patients ( 70.5 % ) continued treatment at home . Nonacceptance was associated with a lower functional status , as measured by the Barthel Index , and the presence of aphasia . Ten days after initiation of nCPAP , compliant users showed a clear improvement in wellbeing ( differences in visual analogue scale ( deltaVAS ) mean+/-SD 26+/-26 mm ) versus noncompliant patients ( deltaVAS 2+/-25 mm , p=0.021 ) . Only the compliant group had a reduction in mean nocturnal blood pressure ( deltaBP ; -8+/-7.3 mmHg versus 0.8+/-8.4 mmHg , p=0.037 ) . Stroke patients with obstructive sleep apnoea can be treated effectively with nasal continuous positive airway pressure and show a similar improvement and primary acceptance to obstructive sleep apnoea patients without stroke . Continuous positive airway pressure acceptance is associated with improved wellbeing and decreased nocturnal blood pressure The authors have investigated whether treatment of sleep apnoea with nasal continuous positive airway pressure ( nCPAP ) improves depressive symptoms , personal activities of daily living ( ADL ) , cognitive functioning and delirium in patients that have suffered a stroke . Sixty-three patients consecutively admitted to a stroke rehabilitation unit 2 - 4 weeks after a stroke , with an apnoea/hypopnoea index > or = 15 , were r and omized to either nCPAP treatment ( n=33 ) or a control group ( n=30 ) . Four patients dropped out after r and omization . Both groups were assessed at baseline and after 7 and 28 nights using the Montgomery-Asberg Depression Rating Scale ( MADRS ) , Barthel-ADL index , and the Mini-Mental State Examination ( MMSE ) scale . Compared to the control group , depressive symptoms ( MADRS total score ) improved in patients r and omized to nCPAP treatment ( p=0.004 ) . No significant treatment effect was found with regard to delirium , MMSE or Barthel-ADL index . Delirium and low cognitive level ( MMSE score ) explained poor compliance with nCPAP .  Depressive symptoms are reduced through nasal continuous positive airway pressure treatment in patients with severe stroke and sleep apnoea .  Compliance with nasal continuous positive airway pressure treatment is a problem in stroke patients , especially when delirium and severe cognitive impairment occur In humans , weak transcranial direct current stimulation ( tDCS ) modulates excitability in the motor , visual , and prefrontal cortex . Periods rich in slow-wave sleep ( SWS ) not only facilitate the consolidation of declarative memories , but in humans , SWS is also accompanied by a pronounced endogenous transcortical DC potential shift of negative polarity over frontocortical areas . To experimentally induce widespread extracellular negative DC potentials , we applied anodal tDCS ( 0.26 mA/cm2 ) repeatedly ( over 30 min ) bilaterally at frontocortical electrode sites during a retention period rich in SWS . Retention of declarative memories ( word pairs ) and also nondeclarative memories ( mirror tracing skills ) learned previously was tested after this period and compared with retention performance after placebo stimulation as well as after retention intervals of wakefulness . Compared with placebo stimulation , anodal tDCS during SWS-rich sleep distinctly increased the retention of word pairs ( p < 0.005 ) . When applied during the wake retention interval , tDCS did not affect declarative memory . Procedural memory was also not affected by tDCS .  Mood was improved both after tDCS during sleep and during wake intervals . tDCS  increased sleep depth toward the end of the stimulation period , whereas the average power in the faster frequency b and s ( θ , α , and β ) was reduced . Acutely , anodal tDCS increased slow oscillatory activity <3 Hz . We conclude that effects of tDCS involve enhanced generation of slow oscillatory EEG activity considered to facilitate processes of neuronal plasticity . Shifts in extracellular ionic concentration in frontocortical tissue ( expressed as negative DC potentials during SWS ) may facilitate sleep-dependent consolidation of declarative memories STUDY OBJECTIVES Obstructive sleep apnea ( OSA ) in stroke patients is associated with worse functional and cognitive status during inpatient re 
    Output:
    
The only nonpharmacological intervention to be administered during sleep in a neurological population to improve physical rehabilitation outcomes was found to be CPAP .
In general , participants who had acceptable to good CPAP compliance saw the largest improvements in physical rehabilitation outcomes .