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Review
. 2024 Oct;166(4):857-866.
doi: 10.1016/j.chest.2024.04.028. Epub 2024 May 28.

Sleep Apnea and Stroke: A Narrative Review

Laavanya Dharmakulaseelan  1 , Mark I Boulos  2
Affiliations
Review

Sleep Apnea and Stroke: A Narrative Review

Laavanya Dharmakulaseelan et al. Chest. 2024 Oct.

Abstract

Topic importance: Stroke is the second-leading cause of death worldwide. OSA is an independent risk factor for stroke and is associated with multiple vascular risk factors. Poststroke OSA is prevalent and closely linked with various stroke subtypes, including cardioembolic stroke and cerebral small vessel disease. Observational studies have shown that untreated poststroke OSA is associated with an increased risk of recurrent stroke, mortality, poorer functional recovery, and longer hospitalizations.

Review findings: Poststroke OSA tends to be underdiagnosed and undertreated, possibly because patients with stroke and OSA present atypically compared with the general population with OSA. Objective testing, such as the use of ambulatory sleep testing or in-laboratory polysomnography, is recommended for diagnosing OSA. The gold standard for treating OSA is CPAP therapy. Randomized controlled trials have shown that treatment of poststroke OSA using CPAP improves nonvascular outcomes such as cognition and neurologic recovery. However, findings from randomized controlled trials that have evaluated the effect of CPAP on recurrent stroke risk and mortality have been largely negative.

Summary: There is a need for high-quality randomized controlled trials in poststroke OSA that may provide evidence to support the utility of CPAP (and/or other treatment modalities) in reducing recurrent vascular events and mortality. This goal may be achieved by examining treatment strategies that have yet to be trialed in poststroke OSA, tailoring interventions according to poststroke OSA endotypes and phenotypes, selecting high-risk populations, and using metrics that reflect the physiologic abnormalities that underlie the harmful effects of OSA on cardiovascular outcomes.

Keywords: CPAP; OSA; ischemic stroke; sleep; sleep-disordered breathing; stroke.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: M. I. B. reports a relationship with Paladin Labs, Jazz Pharmaceuticals, and Eisai that includes consulting or advisory and speaking and lecture fees. The research program of M. I. B. received in-kind support from Braebon Medical Corporation. None declared (L. D.).

Figures

Figure 1
Figure 1
Relationship between OSA and stroke. LAD = large artery disease; SVD = small vessel disease.
See this image and copyright information in PMC

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