BACKGROUND: Central sleep apnea (CSA) syndromes and acute ischemic stroke are linked by a complex, bidirectional relationship. After ischemic stroke, CSA prevalence rises markedly compared with the general population, in which it is usually below 1%. In stroke cohorts, CSA frequencies of around 8%-12% have been reported, although estimates are heterogeneous owing to differing diagnostic criteria. In this scoping review we map the evidence on CSA syndromes during sleep in patients with stroke, summarizing prevalence, mechanisms, clinical correlates, and prognostic implications. METHODS: The Medline (PubMed), Scopus, Cochrane Reviews, and Web of Science databases were searched for observational and interventional studies published from inception to August 31 2025 in English and Spanish assessing CSA syndromes in adults with ischemic stroke. Two reviewers independently screened records, selected studies, and extracted data on study design, stroke characteristics, CSA definitions, comorbidities, and clinical outcomes; disagreements were resolved by consensus with a third reviewer. RESULTS: Fifty-five studies including several thousand patients with ischemic stroke were identified. Across studies, post-stroke CSA prevalence ranged from approximately 8% to 12%, clearly exceeding rates in the general population. CSA was often reported in the absence of overt cardiac comorbidities, and patients with CSA tended to have lower body mass index and fewer classic cardiovascular risk factors than those typically described with obstructive sleep apnea. Pathophysiological analyses emphasized disturbed central ventilatory control after cerebral ischemia; however, several studies did not show a consistent association between specific lesion locations and CSA occurrence, suggesting that stroke may unmask CSA in predisposed individuals rather than cause it solely through focal damage. In older adults, CSA appeared as an independent correlate of ischemic stroke and a potential marker of silent cerebral injury or impaired central respiratory regulation. CONCLUSIONS: Available evidence indicates that CSA syndromes during sleep are substantially more frequent in patients with ischemic stroke than in the general population and may be associated with increased cerebrovascular risk and subclinical brain injury. Heterogeneity in CSA definitions, diagnostic protocols, and outcome measures limits firm conclusions. Standardized criteria and adequately powered prospective studies are needed to clarify the mechanistic and prognostic role of CSA in stroke.
Uscamaita et al. (Tue,) studied this question.