Sleep Disordered Breathing in Transient Ischemic Attack (TIA)/Ischemic Stroke and Continuous Positive Airway Pressure (CPAP) Treatment Efficacy

NCT ID: NCT01097967

Last Updated: 2015-10-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

246 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-07-31

Study Completion Date

2016-04-30

Brief Summary

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The study aims to observe the short term effect (3-month) of sleep disordered breathing (SDB) on cardiovascular parameters, heart rate variability, endothelial function and surrogate markers of atherosclerosis after acute cerebrovascular events (ACE). The long-term effect (6-24-month) of Continuous Positive Airway Pressure (CPAP) on clinical vascular outcome, cardiovascular parameters, evolution of surrogate of atherosclerosis heart rate variability and endothelial function after ACE is observed over 24 months. A preventive effect of CPAP therapy on cerebro-vascular events in patients with moderate-severe obstructive SDB without sleepiness after ictus or transient ischaemic attack will be evaluated.

Detailed Description

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Sleep disordered breathing is an independent risk factor for cardiovascular morbidity and mortality and is frequent in patients with acute cerebrovascular events. In this study the investigators observe the association between sleep disordered breathing, hypertension, stroke and the evolution of blood markers for atherosclerosis as well as the efficacy of Continuous Positive Airway Pressure treatment in patients with acute or subacute cerebrovascular events.

Sleep disordered breathing is an independent risk factor for cardiovascular morbidity and mortality and is frequent in patients with acute cerebrovascular events. In this study the investigators observe the association between sleep disordered breathing, hypertension, stroke and the evolution of blood markers for atherosclerosis as well as the efficacy of Continuous Positive Airway Pressure treatment in patients with acute or subacute cerebrovascular events.

The SAS CARE 1 study is planned to verify whether or not sleep disordered breathing has a detrimental 3 months effect on cardiovascular functions and markers after acute cerebrovascular events. The SAS CARE 2 study is designed to address whether or not the treatment of sleep disordered breathing with CPAP reduces the combined rate of mortality, stroke, cardiovascular events (myocardial infarction/revascularisation/instable angina/ hospitalisation for heart insufficiency) over a 24 months period in patients after acute cerebrovascular events.

Conditions

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TIA Ischemic Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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CPAP in sleepy patients with SDB

SDB defined as AHI \>=20 Sleepy defined as Epworth Sleepiness Score \>=10

Group Type ACTIVE_COMPARATOR

CPAP

Intervention Type OTHER

no CPAP in non sleepy patients with SDB

SDB defined as AHI \>=20 Sleepy defined as Epworth Sleepiness Score \>=10

Group Type NO_INTERVENTION

No interventions assigned to this group

CPAP in non sleepy patients with SDB

SDB defined as AHI \>=20 Sleepy defined as Epworth Sleepiness Score \>=10

Group Type ACTIVE_COMPARATOR

CPAP

Intervention Type OTHER

Interventions

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CPAP

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* ≥ 35 years old and \< 75 years old
* with clinical diagnosis of TIA or ischemic stroke
* admitted in a Stroke Unit within 2 days from onset of symptoms
* or with TIA or ischemic stroke within the last 60-90 days
* signed Informed Consent

Exclusion Criteria

* with unstable clinical situation (cardio-respiratory or life-threatening medical conditions)
* currently on CPAP or on CPAP during the last 3 months before stroke
* with non-ischemic events (intracerebral/subarachnoid haemorrhage)
* Patients with coma/stupor
* with borderline obstructive SDB (AHI 10-19)
* with any condition that interferes with the acceptance of CPAP treatment
Minimum Eligible Age

35 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Swiss National Science Foundation

OTHER

Sponsor Role collaborator

Schweizerische Herzstiftung

OTHER

Sponsor Role collaborator

ResMed

INDUSTRY

Sponsor Role collaborator

Philips Respironics

INDUSTRY

Sponsor Role collaborator

Prof. Claudio Bassetti

OTHER_GOV

Sponsor Role lead

Responsible Party

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Prof. Claudio Bassetti

Dr. med. Claudio Bassetti

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Claudio Bassetti, Professor

Role: PRINCIPAL_INVESTIGATOR

Universitätsspital Bern (Inselspital) und Universität Bern

Carlo Cereda, Capo CLinica

Role: STUDY_CHAIR

Neurocentre of Southern Switzerland, Ospedale Civico

Sebastian Ott, MD

Role: STUDY_CHAIR

Pneumology, University Hospital, Bern

Lino Nobili, Prof. MD

Role: STUDY_CHAIR

Neurology, Stroke Unit, Ospedale Niguarda, Milan, Italy

Mauro Manconi, MD

Role: STUDY_CHAIR

Neurocentre of Southern Switzerland, Ospedale Civico

Peter Young, Prof. MD

Role: STUDY_CHAIR

Universitätsklinik Münster, Zentrum für Schlafmedizin

Locations

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University Hospital Münster

Münster, , Germany

Site Status

Dipartimento Neuroscienze, Ospedale Niguarda

Milan, Lombardy, Italy

Site Status

Inselspital, Universitätsklinik für Pneumologie

Bern, Canton of Bern, Switzerland

Site Status

Ospedale San Giovanni

Bellinzona, Canton Ticino, Switzerland

Site Status

Neurocenter of Southern Switzerland, Ospedale Civico

Lugano, Canton Ticino, Switzerland

Site Status

Countries

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Germany Italy Switzerland

References

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Bassetti C, Aldrich MS, Chervin RD, Quint D. Sleep apnea in patients with transient ischemic attack and stroke: a prospective study of 59 patients. Neurology. 1996 Nov;47(5):1167-73. doi: 10.1212/wnl.47.5.1167.

Reference Type BACKGROUND
PMID: 8909424 (View on PubMed)

Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep. 1999 Mar 15;22(2):217-23. doi: 10.1093/sleep/22.2.217.

Reference Type BACKGROUND
PMID: 10201066 (View on PubMed)

Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005 Mar 19-25;365(9464):1046-53. doi: 10.1016/S0140-6736(05)71141-7.

Reference Type BACKGROUND
PMID: 15781100 (View on PubMed)

Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006 Apr;37(4):967-72. doi: 10.1161/01.STR.0000208215.49243.c3. Epub 2006 Mar 16.

Reference Type BACKGROUND
PMID: 16543515 (View on PubMed)

Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, Soriano Y, Roman-Sanchez P, Illa FB, Canal JM, Duran-Cantolla J. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med. 2009 Jul 1;180(1):36-41. doi: 10.1164/rccm.200808-1341OC. Epub 2009 Apr 30.

Reference Type BACKGROUND
PMID: 19406983 (View on PubMed)

Pace M, Camilo MR, Seiler A, Duss SB, Mathis J, Manconi M, Bassetti CL. Rapid eye movements sleep as a predictor of functional outcome after stroke: a translational study. Sleep. 2018 Oct 1;41(10). doi: 10.1093/sleep/zsy138.

Reference Type DERIVED
PMID: 30032306 (View on PubMed)

Manconi M, Zavalko I, Cereda C, Pisarenco I, Ott S, Fulda S, Bassetti CL. Longitudinal polysomnographic assessment from acute to subacute phase in infratentorial versus supratentorial stroke. Cerebrovasc Dis. 2014;37(2):85-93. doi: 10.1159/000356323. Epub 2014 Jan 16.

Reference Type DERIVED
PMID: 24435018 (View on PubMed)

Cereda CW, Petrini L, Azzola A, Ciccone A, Fischer U, Gallino A, Gyorik S, Gugger M, Mattis J, Lavie L, Limoni C, Nobili L, Manconi M, Ott S, Pons M, Bassetti CL. Sleep-disordered breathing in acute ischemic stroke and transient ischemic attack: effects on short- and long-term outcome and efficacy of treatment with continuous positive airways pressure--rationale and design of the SAS CARE study. Int J Stroke. 2012 Oct;7(7):597-603. doi: 10.1111/j.1747-4949.2012.00836.x. Epub 2012 Jul 19.

Reference Type DERIVED
PMID: 22812731 (View on PubMed)

Related Links

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http://www.eoc.ch

Click here to see more information about our hospital

http://www.swissheart.ch

provides financial support for the study

Other Identifiers

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320030-125069/1

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

EOC.NC.10.01

Identifier Type: -

Identifier Source: org_study_id

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