Sleep Apnea and Stroke: A Narrative Review

Area of Science:

• Neurology
• Cardiology
• Sleep Medicine

Background:

• Stroke is a leading global cause of death.
• Obstructive sleep apnea (OSA) is an independent stroke risk factor, associated with vascular issues.
• Poststroke OSA is prevalent, linked to stroke subtypes and poorer outcomes.

Purpose of the Study:

• To review the current understanding of poststroke OSA.
• To evaluate the diagnostic and therapeutic approaches for poststroke OSA.
• To identify research gaps in managing poststroke OSA.

Main Methods:

• Literature review of observational studies and randomized controlled trials (RCTs) on poststroke OSA.
• Analysis of diagnostic methods like polysomnography and ambulatory sleep testing.
• Evaluation of Continuous Positive Airway Pressure (CPAP) therapy efficacy.

Main Results:

• Poststroke OSA is underdiagnosed and undertreated due to atypical presentations.
• CPAP improves nonvascular outcomes like cognition and neurologic recovery poststroke.
• RCTs have shown limited benefit of CPAP in reducing recurrent stroke and mortality.

Conclusions:

• High-quality RCTs are needed to establish CPAP's efficacy in reducing vascular events and mortality poststroke.
• Future research should explore novel treatment strategies and tailor interventions to patient phenotypes.
• Focusing on high-risk populations and relevant physiological metrics is crucial.