Positional therapy in ischemic stroke patients with obstructive sleep apnea

Anna Svatikova, Ronald D. Chervin, Jeffrey J. Wing, Brisa N. Sanchez, Erin M. Migda, Devin L. Brown

Research output: Contribution to journalArticlepeer-review


Background: Obstructive sleep apnea (OSA) is common in stroke patients and is associated with poor functional outcome. The effects of positional therapy in ischemic stroke patients with OSA have not been investigated. We tested the hypothesis that ischemic stroke patients have less severe OSA during positional therapy that promotes nonsupine positioning. Methods: We conducted a randomized, controlled, cross-over study. Sleep apnea screening studies were performed on two consecutive nights, using a portable respiratory monitoring system, on 18 subjects within the first 14. days of ischemic stroke. An apnea-hypopnea index (AHI) ≥5 established the diagnosis of OSA. Subjects were randomized to positional therapy that included the use of a therapeutic pillow on either the first or second night. On the control night, subjects used the hospital pillow and were positioned ad lib. Treatment effect on AHI was estimated using a repeated measures model. Results: All ischemic stroke subjects studied had OSA. The predominantly male group had a median age of 58years, BMI of 29kg/m2, NIH Stroke Scale score of 3, and a median AHI on the nontherapeutic night of 39 (interquartile range: 21-54). Positional therapy reduced the amount of supine positioning by 36% (95% CI: 18-55% (P<0.001)). The AHI was reduced by 19.5% (95% CI: 4.9-31.9% (P=0.011)), when using positional therapy compared to sleeping ad lib. Conclusions: Positional therapy to avoid supine positioning modestly reduces sleep apnea severity after ischemic stroke, and may therefore improve outcomes.

Original languageEnglish (US)
Pages (from-to)262-266
Number of pages5
JournalSleep Medicine
Issue number3
StatePublished - Mar 2011


  • Cerebrovascular disease
  • Ischemic stroke
  • Obstructive sleep apnea
  • Patient positioning
  • Sleep disorders
  • Treatment

ASJC Scopus subject areas

  • Medicine(all)


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