What is the recommendation for treating patients with OSA using CPAP?
The recommendation for treating patients with OSA using CPAP is consistent with a guideline from the American College of Physicians that recommends CPAP as the initial therapy. Studies of various populations have shown that treatment with CPAP effectively reduces the AHI and improves measures of sleepiness, BP control, sleep-related quality of life, and physical functioning. In studies specifically among patients with stroke, limited data from small trials show that treatment with CPAP is safe, reduces the AHI, improves sleepiness, and may improve neurological function. Evidence from 1 trial suggests that treatment may improve mood. 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. 