Summary

The purpose of this study is to determine whether treatment of obstructive sleep apnea (OSA) with positive airway pressure starting shortly after acute ischemic stroke (1) reduces recurrent stroke, acute coronary syndrome, and all-cause mortality 6 months after the event, and (2) improves stroke outcomes at 3 months in patients who experienced an ischemic stroke.

Age: 18 Years and older

Gender: All

Start Date: 05/09/2019

Primary Completion Date (Estimated): 11/01/2026

Study Completion Date (Estimated): 11/01/2026

Accepts Healthy Volunteers: No

Trial Purpose and Description

Sleep SMART has a prospective, randomized, open-label, blinded-endpoint (PROBE) design. It is a multi-site, parallel-group superiority trial that compares 6 months of OSA treatment to usual care. The study includes two trials: a prevention study with an embedded recovery trial. 3062 subjects will be randomized over 5 years at 110 sites within the NINDS-funded StrokeNet clinical trials network.

Eligibility Criteria

Age: 18 Years and older

Gender: All

Accepts Healthy Volunteers: No

Current Inclusion Criteria, as of 6/28/2024:

1. Ischemic stroke within the prior 7 days.

2. NIH Stroke Scale Score ≥1 at the time of enrollment

Previous Inclusion Criteria, prior to 6/28/2024:

1\. Ischemic stroke or TIA with ABCD ≥4, within prior 14 days.

Exclusion Criteria (for entire time period):

1. pre-event inability to perform all of own basic ADLs

2. unable to obtain informed consent from subject or legally authorized representative

3. incarcerated

4. known pregnancy

5. current mechanical ventilation (can enroll later if this resolves) or tracheostomy

6. current use of positive airway pressure, or use within one month prior to stroke

7. anatomical or dermatologic anomaly that makes use of CPAP interface unfeasible

8. severe bullous lung disease

9. history of prior spontaneous pneumothorax or current pneumothorax

10. hypotension requiring current treatment with pressors (can enroll later if this resolves)

11. other specific medical circumstances that conceivably, in the opinion of the site PI, could render the patient at risk of harm from use of CPAP

12. massive epistaxis or previous history of massive epistaxis

13. cranial surgery or head trauma within the past 6 months, with known or possible CSF leak or pneumocephalus

14. recent hemicraniectomy or suboccipital craniectomy (i.e. those whose bone has not yet been replaced), or any other recent bone removal procedure for relief of intracranial pressure

15. current receipt of oxygen supplementation \>4 liters per minute

16. current contact, droplet, respiratory/airborne precautions