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April 3, 2026Open Access

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

Key Points

The study aims to determine the effect of CPAP therapy on clinical outcomes in stroke patients with obstructive sleep apnea.
Performed a systematic review and meta-analysis of randomized controlled trials.
Literature searched in PubMed, ScienceDirect, and Taylor & Francis using specific keywords.
Primary outcomes assessed included CPAP adherence, dropout rate, functional status, and neurological function.
Mean nightly CPAP use was 4.35 hours, with higher dropout rates in the CPAP group.
CPAP significantly reduced the apnea-hypopnea index by 21.31 events per hour.
No significant improvements were observed in functional or neurological outcomes.

Abstract

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 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.

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