CPAP adherence and depressive symptoms in post-stroke/TIA patients with OSA

Obstructive sleep apnea (OSA) is highly prevalent among patients with stroke and transient ischemic attack (TIA) and is associated with poor outcomes including post-stroke depression. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, however, adherence is low. The relationship between CPAP adherence with post-stroke depression and other outcomes has not been well-defined. This study aimed to evaluate whether CPAP adherence was associated with changes in depressive symptoms and other post-stroke/TIA outcomes. This was a secondary analysis of a prospectively collected cohort study of 112 patients with imaging-confirmed stroke or physician-diagnosed TIA who were diagnosed with OSA via in-laboratory polysomnography or home sleep apnea testing. Of 112 patients, 36 (32.1%) were adherent to CPAP and 76 (67.9%) were non-adherent. When CPAP adherence was modeled continuously, greater weekly CPAP use was associated with reduced depressive symptoms (β = -0.07 per hour/week; 95% CI -0.14 to -0.003; p = 0.04) while controlling for our covariates of interest. Model-based predictions indicated that the estimated change in depressive symptoms became statistically different from no change at approximately 31 h of CPAP use per week. Stroke recurrence occurred only in the non-adherent group (adherent: 0/36, 0%; non-adherent: 3/76, 3.9%). A dose-dependent relationship was observed between greater CPAP use and improvement in depressive symptoms, suggesting benefits beyond a conventional CPAP adherence threshold. These findings highlight the importance of encouraging CPAP use in post-stroke/TIA populations as it may confer clinically meaningful mood benefits.