Positive airway pressure during stroke rehabilitation and functional recovery in people with obstructive sleep apnea

Abstract

Introduction

Obstructive sleep apnea (OSA) is frequent after stroke and may hinder rehabilitation. Whether in-hospital positive airway pressure (PAP) improves functional recovery remains uncertain.

Objective

To determine whether exposure to PAP during inpatient neurorehabilitation is associated with greater gains in functional status compared with no PAP.

Methods

Single-center retrospective cohort of 22 adults with stroke who underwent type-III respiratory polygraphy during inpatient neurorehabilitation. Sleep metrics included the apnea–hypopnea index (AHI), oxygen desaturation index (ODI), CT90 (% of recording time with SpO₂ < 90%), and nadir SpO₂. Functional status at admission and discharge was assessed with the Functional Independence Measure (FIM). Exposure was PAP-treated versus PAP-untreated. The primary endpoint was the change in Total FIM; Motor and Cognitive FIM were secondary endpoints.

Results

Mean age was 65.5 ± 13.6 years; BMI 26.5 ± 6.0 kg·m⁻². OSA burden was high (AHI 39.2 ± 19.0 events·h⁻¹). Baseline demographics, stroke characteristics, and sleep parameters were similar between groups. Total FIM increased by 16.0 ± 12.8 points. Compared with PAP-untreated, PAP-treated patients showed larger gains in ΔTotal FIM (20.3 ± 12.2 vs 6.7 ± 9.0) and ΔMotor FIM (16.1 ± 10.0 vs 4.4 ± 7.8; p = 0.016 and p = 0.013, respectively), whereas ΔCognitive FIM did not differ (p ≥ 0.05). Length of stay and rehabilitation duration were also comparable between groups.

Conclusions

Exposure to PAP during a high-intensity multidisciplinary inpatient neurorehabilitation program lasting approximately 3 months was associated with greater motor and overall functional recovery, without prolonging rehabilitation, compared with no PAP.