Consequences of Obstructive Sleep Apnea Syndrome (OSAS) on the Outcome and the Survival After Ischemic Subtentorial Stroke. Impact of the Treatment With Continuous Positive Airway Pressure (CPAP)

• neurological impairment [ Time Frame: 3 months ] [ Designated as safety issue: No ]

  The variation of the neurological impairment (NIHSS score) at three months after stroke:

  • in four groups of patients depending on their apnea/hypopnea index
  • In the patients group with severe OSAS treated with CPAP from day 15 after stroke vs patients with severe OSAS treated with sham CPAP
• the handicap [ Time Frame: 3 months ] [ Designated as safety issue: No ]

  the handicap (via the Rankin score ), at three months after stroke:

  in four groups of patients depending on their apnea/hypopnea index In the patients group with severe OSAS treated with CPAP from day 15 after stroke vs patients with severe OSAS treated with sham CPAP

• blood pressure [ Time Frame: 3 months ] [ Designated as safety issue: No ]

  The continuous measure of blood pressure over 24 hours at three months after stroke:

  in four groups of patients depending on their apnea/hypopnea index In the patients group with severe OSAS treated with CPAP from day 15 after stroke vs patients with severe OSAS treated with sham CPAP

• the quality of life [ Time Frame: 3 months ] [ Designated as safety issue: No ]

  the quality of life (SF-36) at three months after stroke:

  in four groups of patients depending on their apnea/hypopnea index In the patients group with severe OSAS treated with CPAP from day 15 after stroke vs patients with severe OSAS treated with sham CPAP

• the survival [ Time Frame: 3 months ] [ Designated as safety issue: No ]

  the survival at three months after stroke:

  in four groups of patients depending on their apnea/hypopnea index In the patients group with severe OSAS treated with CPAP from day 15 after stroke vs patients with severe OSAS treated with sham CPAP

Obstructive Sleep Apnea Syndrome (OSAS) is associated with stroke as a risk factor but little is known about the consequences of OSAS on the outcome and the survival after stroke. The aim of the investigators study is first to evaluate the outcome and the survival of patients with stroke depending of OSAS (presence and severity of OSAS) and second to compare the outcome and survival of patients with severe OSAS depending on the treatment of the syndrome with nocturnal continuous positive airway pressure. The investigators hypothesis is that OSAS is associated with worst survival and outcome and needs to be treated at the subacute phase of stroke.

Objective : The aim of our study is to evaluate the consequences of obstructive sleep apnea syndrome on the functional outcome and the survival after an ischemic stroke and to measure the impact of the treatment with continuous positive airway pressure on the outcome of patients with severe obstructive sleep apnea syndrome.Patients and methods : We will prospectively explore by polysomnography, 300 consecutive patients hospitalized for an ischemic stroke in the stroke units of university hospitals at the sub acute phase after stroke (J15±4). 1) We will compare the functional outcome, the neurological impairment, the peripheral endothelial function, the continuous blood pressure measure on 24 hours recording, the quality of life and the survival at 3, 6 and 12 months in four groups of patients depending on their apnea/hypopnea index 2) In patients with severe obstructive sleep apnea syndrome, we will explore the impact on the functional outcome, the neurological impairment, and the survival at 3, 6 et 12 months of a treatment with continuous positive airway pressure (CPAP) randomly compared to a treatment with sham CPAP (non efficacious pressure) during 3 months. Conclusion : This study should allow us to evaluate the consequences of obstructive sleep apnea syndrome on the outcome and the survival after ischemic stroke and the impact and the tolerance of the treatment with continuous positive airway pressure in patients with severe obstructive sleep apnea syndrome.

• Obstructive Sleep Apnea Syndrome
• Brain Infarction

• Device: Continuous Positive Airway pressure-RESPIRONICS
  obstructive sleep apnea syndrome survival ischemic stroke continuous positive airway pressure handicap
• Device: Sham Continuous Positive Airway pressure-RESPIRONICS
  inefficient Continuous Positivie Airway pressure

• No Intervention: apnea/hypopnea index (AHI<5 : no OSAS)
• No Intervention: apnea/hypopnea index (5≥AHI<15 : mild OSAS)
• No Intervention: apnea/hypopnea index (15≤AHI<30 :moderate OSAS)
• Active Comparator: apnea/hypopnea index ( AHI≥30 : severe OSAS treated).
  Treated with CPAP
  Intervention: Device: Continuous Positive Airway pressure-RESPIRONICS
• Sham Comparator: apnea/hypopnea index ( AHI≥30:severe OSAS untreated).
  Treated with sham CPAP (placebo)
  Intervention: Device: Sham Continuous Positive Airway pressure-RESPIRONICS

Inclusion Criteria:

• Brain infarction confirmed by brain imaging

  • follow up possible
  • Severity at admission and at one week follow up:
• NIHSS ≥ 4 or- isolated aphasia (item 9 ofNIHSS ≥ 1) or
• negligence (item 11 du NIHSS ≥ 2) or

• distal motor deficit (score ≥ 1)

  • Health insurance affiliation
  • Inform and free consent agreement