What is the recommendation for treating patients with OSA?
The recommendation is to treat patients with OSA using CPAP, which is consistent with a guideline from the American College of Physicians. Studies of various populations have shown that treatment with CPAP effectively reduced the AHI and improved measures of sleepiness, BP control, sleep-related quality of life, and physical functioning. In addition, 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. Evidence from one 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. As an alternative for patients who do not tolerate CPAP or who prefer mandibular advancement, the American College of Physicians recommends mandibular advancement devices, although these have not been specifically tested in patients with stroke.