Physiologic traits that cause obstructive sleep apnea (OSA) are also associated with adherence to continuous positive airway pressure (CPAP) in patients with stroke and OSA, according to study results published in the American Journal of Respiratory and Critical Care Medicine.

Treating OSA in patients with stroke may help improve neurologic recovery; however, trials are limited by reduced adherence to CPAP. In patients without stroke, reduced rates of CPAP adherence can be predicted based on psychosocial factors, symptoms, and comorbidities, as well as physiologic factors such as arousal threshold (ArTH).

Using polysomnography, researchers hypothesized that physiologic OSA traits are associated with CPAP adherence (eg, low ArTH associated with decreased adherence), and the addition of these traits will improve models of adherence based on established factors (eg, demographic, social, comorbidities, symptoms, and polysomnographic metrics).

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Most patients (82%) had a stroke, with 52% being able to carry out all usual activities after the event, and their mean nightly CPAP use during 6 months was 2.2±2.5 hours per night. The researchers found that pharyngeal muscle compensation, ArTH, and body mass index remained significantly associated with CPAP adherence, and that decreasing ArTH, particularly at lower body mass index, was associated with reduced CPAP adherence. History of transient ischemic attack (TIA), chronic pain, and post-stroke disability were also associated with lower CPAP use. Conversely, baseline sensory deficit and prescription of physical activity/rehabilitation were associated with higher CPAP adherence.

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“… ArTH and pharyngeal muscle compensation are associated with CPAP adherence in patients with TIA/stroke and that this relationship persists after adjustment for established adherence factors,” stated the investigators. “Although prospective validation is needed, our findings suggest that physiologic OSA traits may improve and help personalize prediction of CPAP adherence when incorporated along with the established factors such as psychosocial characteristics, symptoms and comorbidities.”


Zinchuk AV, Redeker NS, Chu JH, et al. Physiologic traits and adherence to obstructive sleep apnea treatment in patients with stroke [published online February 21, 2020]. Am J Respir Crit Care Med. doi:10.1164/rccm.201911-2203LE