Suusgaard Jeppe, West Anders Sode, Ponsaing Laura B, Iversen Helle Klingenberg, Rauen Katrin, Jennum Poul Jørgen
Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
Cerebrovascular Research Center Rigshospitalet, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark.
J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108204. doi: 10.1016/j.jstrokecerebrovasdis.2024.108204. Epub 2024 Dec 17.
Obstructive sleep apnea (OSA) affects about 70 % of stroke patients and is closely linked to stroke development. It is unclear whether treatment with continuous positive airway pressure (CPAP) reduces the risk of stroke recurrence or mortality in post-stroke patients, partly due to limited follow-up time and small sample sizes of previous studies. To close this knowledge gap, this study investigated changes in stroke recurrence and mortality among CPAP-treated post-stroke patients with sleep-disordered breathing.
We conducted a retrospective cohort study using data from the Danish National Patient Registry covering the period from 2003 to 2016, involving 1821 patients diagnosed with sleep-disordered breathing and a prior ischemic stroke or transient ischemic attack (TIA). Patients were categorized into three groups: CPAP users, CPAP-non-users, and no CPAP treatment. We used Cox hazard regression to assess the risk of recurrent stroke or TIA over a 5-year follow-up period, and all-cause mortality over a 14-year follow-up period.
CPAP treatment improved survival rate in CPAP users compared to patients categorized as no CPAP treatment (hazard ratio 0.75, 95 % CI [0.60;0.92], p = 0.007). This effect persisted after adjusting for age, sex, and pre-existing comorbidities within three years (the Quan-updated Charlson Comorbidity Index). There was no difference in recurrence of stroke/TIA among the three CPAP groups.
In this registry-based study, we found that CPAP was associated with a reduction in all-cause mortality in post-stroke/TIA patients with sleep-disordered breathing. CPAP treatment did not seem to affect the risk of re-stroke/TIA during the five years of follow-up.
阻塞性睡眠呼吸暂停（OSA）影响约70%的中风患者，且与中风发展密切相关。持续气道正压通气（CPAP）治疗是否能降低中风后患者中风复发风险或死亡率尚不清楚，部分原因是既往研究随访时间有限且样本量较小。为填补这一知识空白，本研究调查了接受CPAP治疗的睡眠呼吸障碍中风后患者中风复发和死亡率的变化。
我们进行了一项回顾性队列研究，使用丹麦国家患者登记处2003年至2016年期间的数据，纳入1821例被诊断为睡眠呼吸障碍且既往有缺血性中风或短暂性脑缺血发作（TIA）的患者。患者分为三组：CPAP使用者、非CPAP使用者和未接受CPAP治疗者。我们使用Cox风险回归评估5年随访期内复发性中风或TIA的风险，以及14年随访期内全因死亡率。
与未接受CPAP治疗的患者相比，CPAP治疗提高了CPAP使用者的生存率（风险比0.75，95%CI[0.60；0.92]，p = 0.007）。在调整年龄、性别和三年内的既往合并症（更新后的Charlson合并症指数）后，这一效果仍然存在。三个CPAP组之间中风/TIA的复发率没有差异。
在这项基于登记处的研究中，我们发现CPAP与睡眠呼吸障碍的中风后/TIA患者全因死亡率降低有关。在五年的随访期内，CPAP治疗似乎并未影响再次中风/TIA的风险。
