Obstructive Sleep Apnea in Stroke Rehabilitation: A Physical Medicine and Rehabilitation Perspective

Obstructive sleep apnea (OSA) affects up to 70% of stroke survivors and is independently associated with poorer functional outcomes, stroke recurrence, and elevated mortality, yet remains systematically underdiagnosed in rehabilitation settings. This narrative review, conducted following SANRA guidelines using PubMed, Embase, CINAHL, and Web of Science through March 2026, examines the mechanisms by which OSA impairs stroke recovery and evaluates treatment evidence within the rehabilitation context. OSA disrupts neuroplasticity through intermittent hypoxia, fragments sleep architecture critical for motor consolidation, amplifies post-stroke depression and fatigue, and curtails rehabilitation participation. Neuroimaging evidence suggests that OSA-related white matter damage is at least partially reversible with sustained CPAP therapy. CPAP reduces stroke recurrence risk and may improve cognitive and functional outcomes, though adherence remains challenging due to stroke-specific deficits. Oropharyngeal exercises represent a physiatrist-appropriate strategy that may simultaneously address OSA and dysphagia, while weight management and positional therapy offer additional modifiable targets. No PMR-specific OSA management pathway currently exists. This review argues that OSA management belongs within the clinical scope of PMR and proposes a physiatrist-led pathway from admission screening through discharge planning with tele-rehabilitation follow-up.