Devin L Brown1, Valerie Durkalski2, Jeffrey S Durmer3, Joseph P Broderick4, Darin B Zahuranec5, Deborah A Levine6, Craig S Anderson7, Dawn M Bravata8,9, H Klar Yaggi10,11, Lewis B Morgenstern5, Claudia S Moy12, Ronald D Chervin13. 1. Division of Vascular Neurology and Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA. 2. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA. 3. Nox Health, Johns Creek, GA, USA. 4. Department of Neurology and Rehabilitation Medicine, UC Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, OH, USA. 5. Division of Vascular Neurology, Department of Neurology, University of Michigan, Ann Arbor, MI, USA. 6. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 7. Faculty of Medicine, The George Institute for Global Health, UNSW, Sydney, Australia. 8. Department of Internal Medicine and Neurology, Indiana University School of Medicine, Indianapolis, IN, USA. 9. Regenstrief Institute, Indianapolis, USA. 10. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 11. Department of Veterans Affairs Connecticut Healthcare System, Clinical Epidemiology Research Center, West Haven, CT, USA. 12. National Institutes of Neurological Disorders and Stroke, Bethesda, MD, USA. 13. Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA.
Abstract
RATIONALE: Obstructive sleep apnea is common among patients with acute ischemic stroke and is associated with reduced functional recovery and an increased risk for recurrent vascular events. AIMS AND/OR HYPOTHESIS: The Sleep for Stroke Management and Recovery Trial (Sleep SMART) aims to determine whether automatically adjusting continuous positive airway pressure (aCPAP) treatment for obstructive sleep apnea improves clinical outcomes after acute ischemic stroke or high-risk transient ischemic attack. SAMPLE SIZE ESTIMATE: A total of 3062 randomized subjects for the prevention of recurrent serious vascular events, and among these, 1362 stroke survivors for the recovery outcome. METHODS AND DESIGN: Sleep SMART is a phase III, multicenter, prospective randomized, open, blinded outcome event assessed controlled trial. Adults with recent acute ischemic stroke/transient ischemic attack and no contraindication to aCPAP are screened for obstructive sleep apnea with a portable sleep apnea test. Subjects with confirmed obstructive sleep apnea but without predominant central sleep apnea proceed to a run-in night of aCPAP. Subjects with use (≥4 h) ofaCPAP and without development of significant central apneas are randomized to aCPAP plus usual care or care-as-usual for six months. Telemedicine is used to monitor and facilitate aCPAP adherence remotely. STUDY OUTCOMES: Two separate primary outcomes: (1) the composite of recurrent acute ischemic stroke, acute coronary syndrome, and all-cause mortality (prevention) and (2) the modified Rankin scale scores (recovery) at six- and three-month post-randomization, respectively. DISCUSSION: Sleep SMART represents the first large trial to test whether aCPAP for obstructive sleep apnea after stroke/transient ischemic attack reduces recurrent vascular events or death, and improves functional recovery.
RCT Entities:
RATIONALE: Obstructive sleep apnea is common among patients with acute ischemic stroke and is associated with reduced functional recovery and an increased risk for recurrent vascular events. AIMS AND/OR HYPOTHESIS: The Sleep for Stroke Management and Recovery Trial (Sleep SMART) aims to determine whether automatically adjusting continuous positive airway pressure (aCPAP) treatment for obstructive sleep apnea improves clinical outcomes after acute ischemic stroke or high-risk transient ischemic attack. SAMPLE SIZE ESTIMATE: A total of 3062 randomized subjects for the prevention of recurrent serious vascular events, and among these, 1362 stroke survivors for the recovery outcome. METHODS AND DESIGN: Sleep SMART is a phase III, multicenter, prospective randomized, open, blinded outcome event assessed controlled trial. Adults with recent acute ischemic stroke/transient ischemic attack and no contraindication to aCPAP are screened for obstructive sleep apnea with a portable sleep apnea test. Subjects with confirmed obstructive sleep apnea but without predominant central sleep apnea proceed to a run-in night of aCPAP. Subjects with use (≥4 h) of aCPAP and without development of significant central apneas are randomized to aCPAP plus usual care or care-as-usual for six months. Telemedicine is used to monitor and facilitate aCPAP adherence remotely. STUDY OUTCOMES: Two separate primary outcomes: (1) the composite of recurrent acute ischemic stroke, acute coronary syndrome, and all-cause mortality (prevention) and (2) the modified Rankin scale scores (recovery) at six- and three-month post-randomization, respectively. DISCUSSION: Sleep SMART represents the first large trial to test whether aCPAP for obstructive sleep apnea after stroke/transient ischemic attack reduces recurrent vascular events or death, and improves functional recovery.
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