The Effect of Continuous Positive Airway Pressure on Clinical Outcomes in Stroke Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Background and Objective Obstructive sleep apnea (OSA) and stroke share a bidirectional relationship, where OSA increases stroke risk, and stroke predisposes patients to OSA. Continuous positive airway pressure (CPAP) is the gold standard therapy for OSA. This systematic review and meta-analysis aims to determine the effect of CPAP therapy on clinical outcomes in stroke patients with OSA.Methods Literature was searched in PubMed, ScienceDirect, and Taylor & Francis using the keywords “Sleep Apnea, Obstructive,” “Stroke,” and “Continuous Positive Airway Pressure.” Primary outcomes were CPAP adherence, dropout rate, functional status, and neurological function; secondary outcomes included cognitive function, balance, depression, cardiovascular events and mortality, apnea-hypopnea index (AHI), and sleepiness.Results Six randomized controlled trials involving 349 patients (180 CPAP, 169 control) were included. Mean nightly CPAP use was 4.35 hours (95% confidence interval [CI]: 3.41 to 5.29), with a higher dropout rate in the CPAP group (risk ratio=5.41; 95% CI: 2.19 to 13.39; p=0.0003). CPAP did not significantly improve functional status (standardized mean difference [SMD]=0.46; 95% CI: -0.08 to 1.00; p=0.10) or neurological function (SMD=1.18; 95% CI: -0.35 to 2.70; p=0.13), both with high heterogeneity. However, CPAP significantly reduced AHI (mean difference=-21.31; 95% CI: -33.14 to -9.47; p=0.0004) and sleepiness (SMD=-1.43; 95% CI: -2.76 to -0.10; p=0.04).Conclusions Current evidence shows that CPAP improves OSA-specific parameters but remains insufficient to demonstrate benefits in stroke-related clinical outcomes. Larger, long-term studies with earlier CPAP initiation and evaluation of alternative treatments are needed.