Sleepiness, fatigue, and obstructive sleep apnea in stroke patients

Obstructive sleep apnea (OSA) impacts approximately 70 % of stroke patients, often causing fatigue and sleepiness. Although continuous positive airway pressure (CPAP) reduces sleepiness, systematic OSA screening is not standard in post-stroke care, and the effect of untreated OSA on fatigue is unclear. This study investigated changes in sleepiness and fatigue among OSA patients following ischemic stroke or transient ischemic attack (TIA) who underwent CPAP treatment.

This prospective multi-center cohort study, ischemic stroke and TIA patients were screened for OSA using respiratory polygraphy. CPAP-eligible patients (Apnea-Hypopnea Index ≥15) were assessed with the Epworth Sleepiness Scale (ESS) and Visual Analogue Scale-Fatigue (VAS-F) at baseline and seven to eight months post-stroke. CPAP compliance was classified into high (≥70 %), moderate (50-69 %), and low (<50 %) compliance based on nights using CPAP more than four hours per night. Poisson regression models analyzed differences in ESS and VAS-F between compliance groups, with low-compliance as the reference.

Of 2605 patients, 1518 (mean age: 70 ± 12 years; 61 % male) were screened, and 648 were CPAP-eligible. At follow-up, 333 patients were assessed (49 % lost to follow-up). Sleepiness significantly decreased in the high-compliance group compared to low-compliance (p < 0.001). Fatigue levels decreased across all compliance groups, but no differences were observed between groups.

High CPAP compliance in post-stroke or TIA patients with OSA was associated with a reduction in sleepiness but not fatigue. These findings support the recommendation to systematically screen post-stroke patients for OSA and encourage CPAP compliance to mitigate sleepiness.