Can Continuous Positive Airway Pressure Reduce the Risk of Stroke in Obstructive Sleep Apnea Patients? A Systematic Review and Meta-Analysis

Kim YKoo YSLee HYLee SY

PLoS One. 2016 Jan 5;11(1):e0146317. 

PMCID: PMC4701420


   Obstructive Sleep Apnea (OSA) has been shown to increase the risk of stroke. Although, continuous positive airway pressure (CPAP) is considered the treatment of choice for OSA, whether treating OSA with CPAP reduces the risk of stroke remains unclear. So, this current article conducted a systematic review and meta-analysis of all published studies that provided the number of incident strokes in OSA patients in light of their treatment status with CPAP.
   They identified 8 relevant studies: one randomized controlled study (RCT), 5 cohort studies, and 2 studies using administrative health data. Three studies from the same cohort reported different outcomes such as incidence and mortality in different subgroups such as women and the elderly. The studies that analyzed health administrative data were from Danish National Patient Registry records and VA Inpatient and Outpatient Medical SAS data for US veterans. The numbers of subjects (total of 60,186 subjects, which consisted of 18,293 treated and 41,893 untreated patients with OSA). The age of the subjects mostly ranged from their 40s to 60s, except for one cohort study, which included only elderly patients (age 65 and above). Based on a meta-analysis of the cohort studies, treatment with CPAP was associated with lower incidence of stroke and cardiac events with relative risks of 0.27 [0.14-0.53], and 0.54 [0.38-0.75], respectively, although this could not be reproduced in the RCT and the studies using administrative data.
   In conclusion, treating with CPAP in patients with OSA might decrease the risk of stroke, although there is some conflicting evidence. Such effect was more pronounced in stroke than in cardiac events. Future studies analyzing stroke apart from cardiac disease would be of interest.

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