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Our results suggest that long-term CPAP treatment in moderate to severe OSA and ischemic stroke is associated with a reduction in excess risk of mortality.

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Obstructive sleep apnoea (OSA) is a risk factor for stroke, but little is known about the effect of OSA and continuous positive airway pressure (CPAP) on the incidence of long-term, nonfatal cardiovascular events (CVE) in stroke patients.A prospective observational study was made in 223 patients consecutively admitted for stroke. A sleep study was performed on 166 of them. 31 had an apnoea/hypopnoea index (AHI) ,10 events?h -1 ; 39 had an AHI between 10 and 19 events?h -1 and 96 had an AHI o20 events?h -1 . CPAP treatment was offered when AHI was o20 events?h -1 . Patients were followed up for 7 yrs and incident CVE data were recorded.The mean¡SD age of the subjects was 73.3¡11 yrs; mean AHI was 26¡16.7 events?h ; n568) showed an increased adjusted incidence of nonfatal CVE, especially new ischaemic strokes (hazard ratio 2.87, 95% CI 1.11-7.71; p50.03), compared with patients with moderate-to-severe OSA who tolerated CPAP (n528), patients with mild disease ; n536) and patients without OSA (AHI ,10 events?h -1 ; n531). Our results suggest that the presence of moderate-to-severe OSA is associated with an increased long-term incidence of nonfatal CVE in stroke patients and that CPAP reduces the excess of incidence seen in these patients.