sleep smart 1.18.18.ppt - nih strokenet
TRANSCRIPT
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Sleep SMART:Sleep for Stroke Management
And Recovery Trial
Devin L. Brown, MD, MS, PIRonald D. Chervin, MD, MS, PI
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Design
• Phase 3, multicenter• Prospective randomized open-, blinded-
endpoint (PROBE)• Controlled: aPAP vs usual care• Secondary prevention with embedded
recovery trial• Ischemic strokes, high risk TIAs (ABCD2 ≥4)• Randomize ~3,000 participants
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Aims
• Determine whether treatment of OSA with positive airway pressure starting shortly after acute ischemic stroke or high risk TIA:– (1) reduces recurrent stroke, acute coronary
syndrome, and all-cause mortality 6 months after the event
– (2) improves stroke outcomes at 3 months (among those with ischemic stroke)
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Inclusion
• Age ≥18• TIA with ABCD2 ≥4 or ischemic stroke
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Exclusion• pre-event inability to perform all of own basic ADLs • unable to obtain informed consent of subject or representative• incarcerated • known pregnancy• current mechanical ventilation or tracheostomy • current or recent use of positive airway pressure• anatomical or dermatologic barrier to CPAP use • severe bullous lung disease
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Exclusion, cont
• history of spontaneous pneumothorax • hypotension requiring pressors• patient-specific medical risk of harm from CPAP• history of massive epistaxis• cranial surgery or head trauma in past 6 months, with possible
CSF leak or pneumocephalus • recent hemicraniectomy or suboccipital craniectomy
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Schema
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AssessmentsBaseline
with reference
to pre-stroke period Baseline
3 months
6 months
Demographics XStroke risk factors XMedical history (height, weight, etc) XInformant-based prestroke cognitive status (IQCODE) XPre-stroke modified Rankin Scale (mRS) XPre-stroke depression (Patient Health Questionnaire-2 (PHQ-2)) XPost-stroke depression (Patient Health Questionnaire-2 (PHQ-2)) X XBlood pressure X X XEpworth Sleepiness Scale X X XSF-12 and sleep specific QOL measure (FOSQ-10) X XGeneral Morisky Medication Adherence X XFunctional outcome (mRS) X XNeurological outcome (NIHSS) X X XCognitive outcome (mini MoCA) X XQuality of life outcome (short SSQOL) X XAssessment for recurrent stroke, ACS, death X X
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Nox T3
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aCPAP
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• Partnering with a sleep health company• Leverage technology to provide state-of-the-
art telemedicine care to our subjects• aCPAP remotely monitored• Care manager
– technology team– respiratory therapy team– sleep medicine physicians
Telemedicine
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Site selection
• N=110• Exclusions for obvious problems:
– No 24 hr RT coverage– Poor coordinator coverage– Lack of enthusiasm for the trial
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2018
Today
Jan Feb Mar Apr May Jun Jul Aug Sep Oct
DSMB initial meeting3/22/2018
NOA anticipated4/15/2018
Investigator meeting9/28/2018
Site contracts with FusionHealth8/15/2018
First participant enrolled10/15/2018
1/1/2018IRB submission, v1
2/7/2018
1/1/2018 3/19/2018Site selection
Preliminary timeline
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THANK YOU: NINDS (Claudia Moy, Scott Janis),
NCC (Joe Broderick, Jamey Frasure, Judy Spilker), NDMC
(Valerie Durkalski, Yuko Palesch, Jessica Griffin), PREVENTION
WORKING GROUP (Marc Chimowitz, Tom Brott),
FusionHealth (Jeff Durmer)