Early treatment of obstructive apnea and stroke outcome.

word count 200) Question of the study: To assess the impact of nasal continuous positive airway pressure (nCPAP) in ischemic stroke patients followed for 2 years. Materials/patients and methods: Stroke patients with an apnea-hypopnea index ≥20 were randomized to early nCPAP (n = 71) (3–6 days of stroke onset) or conventional treatment (n = 69). The Barthel Index, the Canadian Scale, the Rankin Scale, and the SF-36 were measured at baseline and at 1, 3, 12, and 24 months. Results: The percentage of patients with neurological improvement 1 month after stroke was significantly higher in the nCPAP group (Rankin scale 90.9% vs 56.3%, P < 0.01; Canadian scale 88.2% vs 72.7%, P < 0.05). The mean time until the appearance of cardiovascular events was longer in the nCPAP group (14.9 vs 7.9 months, P = 0.044), although cardiovascular events free survival after 24 months was similar in both groups. The cardiovascular mortality rate was 0% in the nCPAP group and 4.3% in the control group (P = 0.161). Answer to the question: Early use of nCPAP seems to accelerate neurological recovery and to delay the appearance of cardiovascular events, although an improvement in patients’ survival or quality of life was not shown. The study protocol was registered at ClinicalTrials.gov Protocol Registration System (PRS) and the number assigned was NCT00202501.