What is the recommendation for treating patients with OSA?
The recommendation for treating patients with OSA is to use CPAP. This is consistent with a guideline from the American College of Physicians that recommends CPAP as the initial therapy. In studies of various populations, treatment with CPAP effectively reduced the AHI and improved measures of sleepiness, BP control, sleep-related quality of life, and physical functioning. Limited data from small trials specifically among patients with stroke show that treatment with CPAP is safe, reduces the AHI, improves sleepiness, and may improve neurological function. In a planned ancillary analysis in the SAVE trial, which enrolled patients with either coronary or cerebrovascular disease, CPAP reduced the risk for stroke in patients with better CPAP adherence. The American College of Physicians recommends mandibular advancement devices as an alternative for patients who do not tolerate CPAP or who prefer mandibular advancement. These devices, however, have not been specifically tested in patients with stroke. 