The effect of sleep disordered breathing on the outcome of stroke and transient ischemic attack: a systematic review

J Clin Sleep Med. 2014 Jan 15;10(1):103-8. doi: 10.5664/jcsm.3376.


Study objectives: The primary objective was to systematically review the literature on how sleep disordered breathing (SDB) affects recurrence and death among stroke or transient ischemic attack (TIA) patients. A secondary objective was to evaluate how treatment of SDB with continuous positive airway pressure (CPAP) affects the risk of recurrence and death in these patients.

Methods: Adults (18+) with a stroke or TIA diagnosis were eligible for inclusion. Case groups consisted of patients with a sleep disorder. The outcomes of interest were all-cause mortality, recurrent vascular events, and case fatality.

Results: Ten articles covering 1,203 stroke and TIA patients were included in the review. The results generally support a dose-response relationship between severity of SDB and risk of recurrent events and all-cause mortality in stroke and TIA patients. Three small-scale articles with substantial risk of bias evaluated the effects of CPAP therapy, and the results are inconclusive. Data on case fatality is too sparse to be conclusive.

Conclusions: Existing studies provide sufficient data to establish obstructive SDB as a negative predictor of all-cause mortality and recurrent vascular events following stroke or TIA. The ability of CPAP treatment to lower the risk of serious adverse outcomes after stroke remains controversial because of substantial risk of bias identified in most of the eligible studies addressing this relation. Additional studies are needed.

Keywords: Stroke; continuous positive airway pressure; outcome; sleep apnea; sleep disorders; systematic review; transient ischemic attack.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Continuous Positive Airway Pressure / methods
  • Humans
  • Ischemic Attack, Transient / complications*
  • Ischemic Attack, Transient / mortality
  • Middle Aged
  • Patient Outcome Assessment
  • Recurrence
  • Risk Factors
  • Sleep Apnea Syndromes / complications*
  • Sleep Apnea Syndromes / mortality
  • Sleep Apnea Syndromes / therapy
  • Stroke / complications*
  • Stroke / mortality