Abstract：
UNASSIGNED: Stroke is the second-leading cause of death worldwide. OSA is an independent risk factor for stroke and is associated with multiple vascular risk factors. Poststroke OSA is prevalent and closely linked with various stroke subtypes, including cardioembolic stroke and cerebral small vessel disease. Observational studies have shown that untreated poststroke OSA is associated with an increased risk of recurrent stroke, mortality, poorer functional recovery, and longer hospitalizations.
RESULTS: Poststroke OSA tends to be underdiagnosed and undertreated, possibly because stroke patients with OSA present atypically compared with the general population with OSA. Objective testing, such as the use of ambulatory sleep testing or in-laboratory polysomnography, is recommended for diagnosing OSA. The gold standard for treating OSA is CPAP therapy. Randomized controlled trials (RCTs) have shown that treatment of poststroke OSA using CPAP improves nonvascular outcomes such as cognition and neurologic recovery. However, findings from RCTs that have evaluated the effect of CPAP on recurrent stroke risk and mortality have been largely negative.
CONCLUSIONS: There is a need for high-quality RCTs in poststroke OSA that may provide evidence to support the utility of CPAP (and/or other treatment modalities) in reducing recurrent vascular events and mortality. This goal may be achieved by examining treatment strategies that have yet to be trialed in poststroke OSA, tailoring interventions according to poststroke OSA endotypes and phenotypes, selecting high-risk populations, and using metrics that reflect the physiological abnormalities that underlie the harmful effects of OSA on cardiovascular outcomes.
RESULTS: Poststroke OSA tends to be underdiagnosed and undertreated, possibly because stroke patients with OSA present atypically compared with the general population with OSA. Objective testing, such as the use of ambulatory sleep testing or in-laboratory polysomnography, is recommended for diagnosing OSA. The gold standard for treating OSA is CPAP therapy. Randomized controlled trials (RCTs) have shown that treatment of poststroke OSA using CPAP improves nonvascular outcomes such as cognition and neurologic recovery. However, findings from RCTs that have evaluated the effect of CPAP on recurrent stroke risk and mortality have been largely negative.
CONCLUSIONS: There is a need for high-quality RCTs in poststroke OSA that may provide evidence to support the utility of CPAP (and/or other treatment modalities) in reducing recurrent vascular events and mortality. This goal may be achieved by examining treatment strategies that have yet to be trialed in poststroke OSA, tailoring interventions according to poststroke OSA endotypes and phenotypes, selecting high-risk populations, and using metrics that reflect the physiological abnormalities that underlie the harmful effects of OSA on cardiovascular outcomes.
摘要：
■中风是全球第二大死亡原因。阻塞性睡眠呼吸暂停(OSA)是脑卒中的独立危险因素,且与多种血管危险因素相关。卒中后OSA很普遍，与各种卒中亚型密切相关，包括心源性卒中和脑小血管病。观察性研究表明，未经治疗的卒中后OSA与卒中复发风险增加有关。死亡率,功能恢复较差，住院时间较长。
结果：卒中后OSA往往未被诊断和治疗不足，可能是因为与OSA的普通人群相比，OSA的卒中患者非典型。客观测试,例如使用动态睡眠测试或实验室多导睡眠图，推荐用于诊断OSA。治疗OSA的金标准是持续气道正压通气(CPAP)治疗。随机对照试验（RCT）表明，使用CPAP治疗卒中后OSA可改善非血管结局，例如认知和神经系统恢复。然而,评估CPAP对复发性卒中风险和死亡率影响的RCT大部分为阴性。
结论：卒中后OSA需要高质量的RCTs，这些RCTs可以提供支持CPAP（和/或其他治疗方式）在减少复发性血管事件和死亡率方面的效用的证据。这可以通过检查尚未在卒中后OSA中进行试验的治疗策略来实现。根据卒中后OSA基因型和表型定制干预措施，选择高风险人群，并使用反映OSA对心血管结局有害影响的生理异常的指标。
结果：卒中后OSA往往未被诊断和治疗不足，可能是因为与OSA的普通人群相比，OSA的卒中患者非典型。客观测试,例如使用动态睡眠测试或实验室多导睡眠图，推荐用于诊断OSA。治疗OSA的金标准是持续气道正压通气(CPAP)治疗。随机对照试验（RCT）表明，使用CPAP治疗卒中后OSA可改善非血管结局，例如认知和神经系统恢复。然而,评估CPAP对复发性卒中风险和死亡率影响的RCT大部分为阴性。
结论：卒中后OSA需要高质量的RCTs，这些RCTs可以提供支持CPAP（和/或其他治疗方式）在减少复发性血管事件和死亡率方面的效用的证据。这可以通过检查尚未在卒中后OSA中进行试验的治疗策略来实现。根据卒中后OSA基因型和表型定制干预措施，选择高风险人群，并使用反映OSA对心血管结局有害影响的生理异常的指标。
