Effect of CPAP Therapy in Poststroke Patients with Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis

INTRODUCTION: Sleep-disordered breathing (SDB), particularly obstructive sleep apnea, increases the risk of first and recurrent stroke. SDB is common after stroke or transient ischemic attack (TIA) and is linked with fatigue, sleepiness, and poorer cognitive and functional outcomes. Continuous positive airway pressure (CPAP) therapy may mitigate these effects, but its efficacy in post-stroke populations remains uncertain. METHODS: Following a preregistered PROSPERO protocol (CRD420251078235), we systematically searched MEDLINE, Embase, and Cochrane CENTRAL. Eligible studies included adults with stroke or TIA and SDB, comparing CPAP with sham, usual care, or nonadherence. Primary outcomes were recurrent stroke or TIA and all-cause mortality; secondary outcomes included cardiac events, functional recovery, cognition, sleepiness, and fatigue. Random effects models were used separately for randomized controlled trials (RCTs) and observational studies. RESULTS: From 7,132 records, 30 studies (19 RCTs, 11 observational studies; n = 3,381) met inclusion criteria. Seven RCTs assessed recurrent stroke or TIA and showed CPAP reduced the odds of re-stroke (OR: 0.49, 95% CI: 0.25-0.95; I2 = 0%). All-cause mortality was unchanged in short-term RCTs, but long-term unadjusted observational data showed lower all-cause mortality with CPAP (OR: 0.50, 95% CI: 0.39-0.63; I2 = 0%). High CPAP adherence was linked to improved functional and cognitive outcomes and reduced sleepiness, though data on fatigue and cardiac events were limited. CONCLUSION: CPAP therapy after stroke or TIA may reduce stroke recurrence and all-cause mortality, while improvements in sleepiness and functional and cognitive outcomes appear less consistent and largely adherence dependent.