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Sleep Disorders and Stroke: Does Treatment of Obstructive Sleep Apnea Decrease Risk of Ischemic Stroke?

  • Melvin Parasram
  • Alan Z. SegalEmail author
Cerebrovascular Disorders (D Jamieson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cerebrovascular Disorders

Abstract

Purpose of review

This review aims to support obstructive sleep apnea (OSA) as a risk factor for ischemic stroke, review treatment strategies for OSA, provide a comprehensive review of clinical data on OSA treatment and ischemic stroke risk, and to critically assess if treatment of OSA decreases the risk of ischemic stroke and if treatment improves outcomes and subsequent ischemic stroke risk in post-stroke patients.

Recent findings

Several observational studies, randomized controlled trials (RCTs), and meta-analyses have examined the risk of ischemic stroke and cardiovascular events in patients with OSA and have also examined continuous positive airway pressure (CPAP) treatment in these patients. Observational studies have shown an increased risk of ischemic stroke in patients with untreated OSA when compared with patients treated with CPAP; however, results are not statistically significant. RCTs and meta-analyses have shown no significant ischemic stroke risk reduction in CPAP treated patients with OSA. Several studies have shown improved outcomes in post-stroke patients with OSA treated with CPAP; however, few data is available for subsequent ischemic stroke risk reduction. Further research is needed for surgical treatment of OSA and assessment of ischemic stroke risk.

Summary

OSA is associated with increased risk of ischemic stroke, and OSA should be treated with the appropriate therapy. While the current data is promising, more studies are necessary to state whether treatment of OSA reduces ischemic stroke risk and subsequent ischemic stroke risk. A practical approach to the sleep disorder evaluation and treatment of patients with cerebrovascular disease is outlined.

Keywords

Obstructive sleep apnea Stroke Cardiovascular risk Cerebrovascular risk Continuous positive airway pressure 

Abbreviations

BQ

Berlin questionnaire

CAD

coronary artery disease

ESS

Epworth sleepiness scale

HNS

hypoglossal nerve stimulation

HR

hazard ratio

mRS

modified Rakin Scale

NIHSS

National Institutes of Health Stroke Scale

OSA

obstructive sleep apnea

PSG

polysomnography

RCT

randomized controlled trials

RICCADSA

Randomized Intervention with Continuous Positive Airway Pressure in Coronary Artery Disease and Obstructive Sleep Apnea

RR

relative risk

r-tPA

recombinant tissue plasminogen activity

SAVE

Sleep Apnea Cardiovascular Endpoint

SBQ

STOP-BANG questionnaire

SDB

sleep-disordered breathing

SMD

standardized mean differences

STAR

Stimulation Therapy for Apnea Reduction

TCRFTA

temperature-controlled radiofrequency tissue ablation

TIA

transient ischemic attack

UPPP

Uvulopalatopharyngoplasty

US

United States

VS

versus

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Department of NeurologyWeill Cornell MedicineNew YorkUSA

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