Browsing by Author "Struve, Frederick"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack: a randomized feasibility trial
    (Ovid Technologies Wolters Kluwer -American Heart Association, 2010-07) Bravata, Dawn M.; Concato, John; Fried, Terri; Ranjbar, Noshene; Sadarangani, Tanesh; McClain, Vincent; Struve, Frederick; Zygmunt, Lawrence; Knight, Herbert J.; Lo, Albert; Richerson, George B.; Gorman, Mark; Williams, Linda S.; Brass, Lawrence M.; Agostini, Joseph; Mohsenin, Vahid; Roux, Francoise; Klar Yaggi, H.; Department of Medicine, IU School of Medicine
    BACKGROUND AND PURPOSE: Transient ischemic attack (TIA) patients are at risk of recurrent vascular events. The primary objectives were to evaluate among TIA patients the prevalence of sleep apnea and among patients with sleep apnea auto-titrating continuous positive airway pressure (auto-CPAP) adherence. The secondary objective was to describe among TIA patients with sleep apnea the recurrent vascular event rate by auto-CPAP use category. METHODS: All intervention patients received auto-CPAP for 2 nights, but only intervention patients with evidence of sleep apnea received auto-CPAP for the remainder of the 90-day period. Intervention patients received polysomnography at 90 days after TIA. Control patients received polysomnography at baseline and at 90 days. Acceptable auto-CPAP adherence was defined as >or=4 hours per night for >or=75% of nights. Vascular events included recurrent TIA, stroke, hospitalization for congestive heart failure, myocardial infarction, or death. RESULTS: We enrolled 70 acute TIA patients: 45 intervention and 25 control. The majority of patients had sleep apnea: 57% at baseline and 59% at 90 days. Among the 30 intervention patients with airflow obstruction, 12 (40%) had acceptable auto-CPAP adherence, 18 (60%) had some use, and none had no use. Three intervention patients (12%) had recurrent events compared with 1 (2%;P=0.13) control patient. The vascular event rate was highest among sleep apnea patients with no CPAP use: none, 16%;some, 5%;acceptable adherence 0% (P=0.08). CONCLUSIONS: Sleep apnea is common among acute TIA patients. It appears feasible to provide auto-CPAP in the acute TIA period. Larger studies should evaluate whether a strategy of diagnosing and treating sleep apnea can reduce recurrent vascular events after TIA.
  • Thumbnail Image
    Item
    Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting
    (2010) Schmid, Arlene A.; Wells, Carolyn K; Concato, John; Dallas, Mary I; Lo, Albert C.; Nadeau, Steven E; Williams, Linda S.; Peixoto, Aldo J; Gorman, Mark; Boice, John L.; Struve, Frederick; McClain, Vincent; Bravata, Dawn M.
    Abstract—Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] 8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46–9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70–13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22–79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS 8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke.