# Continuous positive airway pressure in acute ischemic stroke patients with obstructive sleep apnea: analysis of the National Inpatient Sample database

## TL;DR

This study analyzed hospital data to assess the impact of CPAP on outcomes for stroke patients with sleep apnea, finding mixed results.

## Contribution

The study identifies independent predictors of CPAP use and its mixed associations with hospitalization outcomes in AIS-OSA patients.

## Key findings

- CPAP-treated AIS-OSA patients had longer hospital stays, higher costs, and increased in-hospital mortality.
- CPAP-treated patients also had higher rates of routine discharge, suggesting better long-term outcomes.
- Advanced age, Black race, heart failure, and obesity were independent predictors of CPAP treatment.

## Abstract

Obstructive sleep apnea (OSA) is an established independent risk factor for stroke. However, the efficacy of continuous positive airway pressure (CPAP) in patients with acute ischemic stroke and comorbid OSA (AIS-OSA) remains uncertain. This study aimed to assess the impact of CPAP on hospitalization outcomes for AIS-OSA patients using data from the National Inpatient Sample (NIS).

A retrospective data analysis was conducted using the NIS to identify patients hospitalized with a diagnosis of AIS-OSA between 2010 and 2019 with complete data. Patients were categorized into two groups based on CPAP treatment during hospitalization. Logistic regression analyses were performed to identify factors associated with CPAP treatment.

Among 103,004 patients with AIS-OSA, those who received CPAP had statistically significant longer lengths of stay (LOS), higher medical expenses, and increased in-hospital mortality rates. Conversely, this group also exhibited higher proportions of routine discharges, suggesting potentially improved long-term outcomes. Independent predictors for CPAP treatment included advanced age, Black race, congestive heart failure, and obesity. Besides, factors such as pneumonia, acute myocardial infarction, pulmonary embolism, intracranial hemorrhage, thrombolysis, and mechanical thrombectomy may be associated with CPAP treatment, but this association does not imply causation.

This study identified independent predictors and associated factors for CPAP treatment in hospitalized AIS-OSA patients. Our observation may suggest that surviving patients who received CPAP treatment had more favorable prognoses, however, randomized trials are needed to determine causality.