Prevalence of obstructive sleep apnea risk in stroke patients and its association with stroke severity and recurrence in Pakistan: a cross-sectional study

Abstract Obstructive sleep apnea (OSA) is highly prevalent among stroke patients and may adversely affect stroke outcomes. However, data from South Asian populations, particularly Pakistan, remain scarce. This study aimed to determine the prevalence of OSA risk in stroke patients from the twin cities of Rawalpindi and Islamabad and to evaluate its association with stroke severity and recurrence. A cross-sectional study was conducted among 306 stroke patients recruited from hospitals, rehabilitation centres, and stroke units between June and September 2024. OSA risk was assessed using the STOP-BANG questionnaire, and stroke severity was evaluated with the National Institutes of Health Stroke Scale (NIHSS). Associations between OSA risk categories and stroke severity and recurrence were analysed using chi-square tests. Of the 306 participants (54.9% male, 95% CI 49.3–60.5; the majority were aged 46–60 years), 41.8% (95% CI 36.3–47.4) were classified as high risk, 35.0% (95% CI 29.6–40.3) as intermediate risk, and 23.2% (95% CI 18.5–27.9) as low risk for OSA. Ischemic stroke was the most common subtype (71.2%, 95% CI 66.1–76.3). Stroke recurrence was reported in 48.0% of participants (95% CI 42.4–53.6). Higher OSA risk was significantly associated with greater stroke severity (χ² = 53.444, p < 0.001; OR for moderate-to-severe stroke, high- versus low-risk, 11.87, 95% CI 5.41–26.05) and increased stroke recurrence (χ² = 36.893, p < 0.001; OR for high- versus low-risk, 6.80, 95% CI 3.49–13.24). A high proportion of stroke patients in Pakistan screened at intermediate-to-high risk for OSA using STOP-BANG, and OSA risk category was significantly associated with both stroke severity and recurrence. These findings are descriptive and hypothesis-generating; prospective studies with objective OSA testing and multivariable adjustment for shared risk factors are needed before OSA screening can be recommended as a modifiable target in routine post-stroke care.