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

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

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.

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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

References and Recommended Reading

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  1. Department of Neurology, Weill Cornell Medicine, 520 East 70th Street Starr-607, New York, NY, 10021, USA

    Melvin Parasram DO, MS & Alan Z. Segal MD

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  1. Melvin Parasram DO, MS
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Parasram, M., Segal, A.Z. Sleep Disorders and Stroke: Does Treatment of Obstructive Sleep Apnea Decrease Risk of Ischemic Stroke?. Curr Treat Options Neurol 21, 29 (2019). https://doi.org/10.1007/s11940-019-0575-0

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