Can Continuous Positive Airway Pressure Reduce the Risk of Stroke in Obstructive Sleep Apnea Patients? A Systematic Review and Meta-Analysis

Abstract

Background and PurposeObstructive sleep apnea (OSA) has been shown to increase the risk of stroke. Although continuous positive airway pressure (CPAP) is considered the treatment of choice for OSA, whether treating OSA with CPAP reduces the risk of stroke remains unclear. We aimed to evaluate the effects of CPAP on incidence of stroke in patients with OSA.Materials and MethodsWe conducted a systematic review and meta-analysis of all published studies that provided the number of incident strokes in OSA patients in light of their treatment status with CPAP.ResultsWe identified 8 relevant studies: one randomized controlled study (RCT), 5 cohort studies, and 2 studies using administrative health data. The two overlapping cohort studies in women and the elderly and the 2 studies using administrative health data had analyzed the impact of CPAP on stroke apart from cardiac events, whereas the others had focused on the overall cardiovascular events. Based on a meta-analysis of the cohort studies, treatment with CPAP was associated with a lower incidence of stroke and cardiac events with relative risks of 0.27 [0.14–0.53], and 0.54 [0.38–0.75], respectively, although this could not be reproduced in the RCT and the studies using administrative data.ConclusionsTreating with CPAP in patients with OSA might decrease the risk of stroke, although there is some conflicting evidence. Such effect was more pronounced in stroke than in cardiac events. Future studies analyzing stroke apart from cardiac disease would be of interest.

Management and Risk Reduction of Rheumatoid Arthritis in Individuals with Obstructive Sleep Apnea: A Nationwide Population-Based Study in Taiwan

“…7 However, CPAP is underused as a therapy for OSA even though investigators have demonstrated that CPAP may reduce the risk of atrial fibrillation or stroke. 46 Results of the current study also revealed that CPAP may reduce the risk of RA in patients with OSA depending on the extent of decrease of inflammatory mediators and oxidative stress.…”

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

“…Systematic reviews: Four studies were included [69][70][71][72]. The original studies included in the systematic reviews were of class I or II quality.…”

Sleep Apnea

“…Sleep apnea is highly prevalent in patients with stroke or TIA, and OSA also is associated with increased risk for incident stroke (46–48). There is some evidence that early CPAP therapy has positive effects on long-term survival in ischemic stroke patients with moderate-to-severe OSA (46–48).…”

“…There is some evidence that early CPAP therapy has positive effects on long-term survival in ischemic stroke patients with moderate-to-severe OSA (46–48). Additionally, consistent with observational studies (46–48), in a recent large RCT (49), those OSA patients who were adherent to CPAP therapy exhibited reduced risk of incident cerebral events.…”