The University of Michigan announced last week that it would be leading a $45 million study to look at how people could benefit from sleep apnea treatment after a stroke. The study will build on research we highlighted earlier this year, showing that people with sleep apnea after a stroke were more likely to have a second stroke or die. Hopefully, treating sleep apnea will help stroke survivors recover and avoid subsequent strokes.
The study is called Sleep SMART, which stands for “Sleep for Stroke Management and Recovery Trial.” Investigators say that about 70% of stroke survivors have sleep apnea, and that their sleep apnea could put them at higher risk for future strokes and even death.
They say that the relationship between sleep apnea and stroke in all these cases is not completely clear. Some people may have had a stroke because they had sleep apnea. Others might have developed sleep apnea as a result of the stroke. And it may be a mixture of the two. But since the presence of sleep apnea indicates risk for future stroke, the possibility that treatment could improve outcomes makes this a very appealing opportunity. Stroke recovery is hard to manage. People have better outcomes if they get faster treatment, but otherwise it’s hard to help stroke patients.
The trial will be conducted at 110 sites around the country, where researchers hope to recruit at least 3000 post-stroke patients for this first-of-its-kind randomized clinical trial. Randomized clinical trials are considered the gold standard for determining whether a treatment is effective for helping patients.
The study will also be aided by a prompt timeline: patients will get treatment for sleep apnea starting in the hospital. That gives the treatment the most possible time to make a difference. Patients will then be assessed for outcomes at three and six months after starting sleep apnea treatment.
A Weakness in the Study
However, there is one significant weakness in the study: it only uses CPAP. This is not too big a surprise in the end, since many still consider CPAP to be the best treatment for sleep apnea. And it is, if you use it. When you use CPAP, you are essentially 100% cured of your sleep apnea.
But many people don’t use it. In fact, some studies show that as little as 50% of people who have been prescribed CPAP will actually use it. This means people who don’t use their CPAP essentially have untreated sleep apnea. In a study, it also means that the actual study population is much smaller than intended.
With a $45 million study that is trying to recruit 3000 people, you would think that researchers wouldn’t want to risk losing some of their study population. And you would think that researchers would learn from earlier studies. There have been multiple studies on the effectiveness of sleep apnea treatment that show no effect in part because so few CPAP users complied with their treatment. It would be nice to see a study like this that incorporated an oral appliance protocol for the study population: people who couldn’t tolerate CPAP would be given oral appliance therapy.
Nonetheless, we hope that this study shows true benefit of sleep apnea treatment for stroke survivors.
Are You Looking for Sleep Apnea Treatment in the Detroit Area?
If you have or suspect you have sleep apnea in the Detroit area, we can help you get the best treatment, including helping you get an oral appliance if your CPAP doesn’t work for you.
To learn more about your sleep apnea treatment options, please call (248) 825-8277 today for an appointment with sleep dentist Dr. Jeffrey S. Haddad at the Michigan Center for TMJ & Sleep Wellness in Troy, MI.