Evidence map›Paper›PMID 28386781›Full record

Trial reportSleep & breathing = Schlaf & Atmung2017

Diagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy.

Dawn M Bravata, Vincent McClain, Charles Austin, Jared Ferguson, Nicholas Burrus, Edward J Miech, Marianne S Matthias, Neale Chumbler, Susan Ofner, Brian Foresman and 6 more

Open access · hybridAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Sleep & breathing = Schlaf & Atmung, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. International Consensus Statement on Obstructive Sleep Apnea.International forum of allergy & rhinology · 2023
    Review
  5. Review
  6. Article
  7. Article
  8. Article
  9. Article
  10. The Evolution of Sleep Apnea Six Months After Acute Ischemic Stroke and Thrombolysis.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2018
    Article
  11. Obstructive sleep apnea and stroke: hand in hand?Journal of thoracic disease · 2018
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 7 institutions in 1 country.

Dawn M BravataVA HSR&D Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA. Dawn.Bravata2@va.gov.
Vincent McClainRegenstrief Institute, Indianapolis, IN, USA.
Charles AustinDepartment of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Jared FergusonDepartment of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Nicholas BurrusVA HSR&D Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA.
Edward J MiechVA HSR&D Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA.
Marianne S MatthiasVA HSR&D Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA.
Neale ChumblerHealth Policy and Management, University of Georgia, Athens, GA, USA.
Susan OfnerDepartment of Biostatistics, Indiana University School of Medicine, IUPUI, Indianapolis, IN, USA.
Brian ForesmanDepartment of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Jason SicoVA Connecticut Healthcare System, West Haven, CT, USA.
Carlos A Vaz FragosoVA Connecticut Healthcare System, West Haven, CT, USA.
Linda S WilliamsVA HSR&D Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 West 10th Street, Indianapolis, IN, 46202, USA.
Rajiv AgarwalDepartment of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
John ConcatoDepartment of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
H Klar YaggiVA Connecticut Healthcare System, West Haven, CT, USA.
Indiana University – Purdue University Indianapolis · USIndiana University School of MedicineYale University · USRegenstrief Institute · USQuality Enhancement Research Initiative · USUniversity of Georgia · USVA Connecticut Healthcare System · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Department of Veterans Affairs, Health Services Research and Development Service IIR-06-233-2HSRD VA CDA 10-034NCATS NIH HHS UL1 TR001863
6 · The paper itself

Abstract

backgroundObstructive sleep apnea is common and associated with poor outcomes after stroke or transient ischemic attack (TIA). We sought to determine whether the intervention strategy improved sleep apnea detection, obstructive sleep apnea (OSA) treatment, and hypertension control among patients with chronic cerebrovascular disease and hypertension.

methodsIn this randomized controlled strategy trial intervention, patients received unattended polysomnography at baseline, and patients with OSA (apnea-hypopnea index ≥5 events/h) received auto-titrating continuous positive airway pressure (CPAP) for up to 1 year. Control patients received usual care and unattended polysomnography at the end of the study, to identify undiagnosed OSA. Both groups received 24-h blood pressure assessments at baseline and end of the study. "Excellent" CPAP adherence was defined as cumulative use of ≥4 h/night for ≥70% of the nights.

resultsAmong 225 randomized patients (115 control; 110 intervention), 61.9% (120/194) had sleep apnea. The strategy successfully diagnosed sleep apnea with 97.1% (102/105) valid studies; 90.6% (48/53, 95% CI 82.7-98.4%) of sleep apnea was undiagnosed among control patients. The intervention improved long-term excellent CPAP use: 38.6% (22/57) intervention versus 0% (0/2) control (p < 0.0001). The intervention did not improve hypertension control in this population with well-controlled baseline blood pressure: intervention, 132.7 mmHg (±standard deviation, 14.1) versus control, 133.8 mmHg (±14.0) (adjusted difference, -1.1 mmHg, 95% CI (-4.2, 2.0)), p = 0.48).

conclusionsPatients with cerebrovascular disease and hypertension have a high prevalence of OSA. The use of portable polysomnography, and auto-titrating CPAP in the patients' homes, improved both the diagnosis and the treatment for sleep apnea compared with usual care but did not lower blood pressure.

Indexed as

Continuous Positive Airway PressureHome Care ServicesAgedAged, 80 and overBlood PressureCerebrovascular DisordersFemaleHumansHypertensionMaleMiddle AgedPolysomnographySleep Apnea, ObstructiveTreatment OutcomeIschemic strokeSleep apnea diagnosisSleep apnea treatmentTransient ischemic attack

Identifiers

PMID28386781
PMCPMC5585280
OpenAlexW2605102479

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.