Suusgaard Jeppe, West Anders Sode, Frandsen Rune, Iversen Helle Klingenberg, Kruuse Christina, Rauen Katrin, Loft Belle Mia Ingerslev, Dysted Camilla, Jennum Poul Jørgen
Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark.
Clinical Stroke Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark.
J Stroke Cerebrovasc Dis. 2025 Aug;34(8):108345. doi: 10.1016/j.jstrokecerebrovasdis.2025.108345. Epub 2025 May 18.
Obstructive sleep apnea (OSA) impacts approximately 70 % of stroke patients, often causing fatigue and sleepiness. Although continuous positive airway pressure (CPAP) reduces sleepiness, systematic OSA screening is not standard in post-stroke care, and the effect of untreated OSA on fatigue is unclear. This study investigated changes in sleepiness and fatigue among OSA patients following ischemic stroke or transient ischemic attack (TIA) who underwent CPAP treatment.
This prospective multi-center cohort study, ischemic stroke and TIA patients were screened for OSA using respiratory polygraphy. CPAP-eligible patients (Apnea-Hypopnea Index ≥15) were assessed with the Epworth Sleepiness Scale (ESS) and Visual Analogue Scale-Fatigue (VAS-F) at baseline and seven to eight months post-stroke. CPAP compliance was classified into high (≥70 %), moderate (50-69 %), and low (<50 %) compliance based on nights using CPAP more than four hours per night. Poisson regression models analyzed differences in ESS and VAS-F between compliance groups, with low-compliance as the reference.
Of 2605 patients, 1518 (mean age: 70 ± 12 years; 61 % male) were screened, and 648 were CPAP-eligible. At follow-up, 333 patients were assessed (49 % lost to follow-up). Sleepiness significantly decreased in the high-compliance group compared to low-compliance (p < 0.001). Fatigue levels decreased across all compliance groups, but no differences were observed between groups.
High CPAP compliance in post-stroke or TIA patients with OSA was associated with a reduction in sleepiness but not fatigue. These findings support the recommendation to systematically screen post-stroke patients for OSA and encourage CPAP compliance to mitigate sleepiness.
阻塞性睡眠呼吸暂停（OSA）影响约70%的中风患者，常导致疲劳和嗜睡。尽管持续气道正压通气（CPAP）可减轻嗜睡，但在中风后护理中，系统性OSA筛查并非标准操作，且未经治疗的OSA对疲劳的影响尚不清楚。本研究调查了接受CPAP治疗的缺血性中风或短暂性脑缺血发作（TIA）后OSA患者的嗜睡和疲劳变化。
这项前瞻性多中心队列研究中，使用呼吸多导记录仪对缺血性中风和TIA患者进行OSA筛查。符合CPAP治疗条件的患者（呼吸暂停低通气指数≥15）在基线时以及中风后七至八个月时，使用爱泼沃斯嗜睡量表（ESS）和视觉模拟疲劳量表（VAS-F）进行评估。根据每晚使用CPAP超过四小时的天数，将CPAP依从性分为高（≥70%）、中（50-69%）和低（<50%）依从性。泊松回归模型分析了依从性组之间ESS和VAS-F的差异，以低依从性组作为参照。
在2605例患者中，1518例（平均年龄：70±12岁；61%为男性）接受了筛查，648例符合CPAP治疗条件。在随访时，对333例患者进行了评估（49%失访）。与低依从性组相比，高依从性组的嗜睡情况显著改善（p<0.001）。所有依从性组的疲劳水平均有所下降，但组间未观察到差异。
中风或TIA后OSA患者的高CPAP依从性与嗜睡减轻有关，但与疲劳无关。这些发现支持对中风后患者进行系统性OSA筛查的建议，并鼓励提高CPAP依从性以减轻嗜睡。
