Open AccessContinuous positive pressure therapy usage and incident stroke in patients with obstructive sleep apnea: A nationwide population‐based cohort study
Author(s) -
Chang EnTing,
Chen Weishan,
Wang LingYi,
Chen ShihFen,
Hsu ChungY,
Shen YuChih
Publication year - 2020
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.13214
Subject(s) - medicine , continuous positive airway pressure , stroke (engine) , obstructive sleep apnea , hazard ratio , incidence (geometry) , confidence interval , sleep apnea , population , proportional hazards model , cohort study , positive airway pressure , emergency medicine , physical therapy , mechanical engineering , physics , environmental health , optics , engineering
Continuous positive airway pressure (CPAP) is the main treatment for obstructive sleep apnea (OSA). To date, the link between CPAP usage and incident stroke has been inconsistent. Objective This nationwide population study is designed to examine the effect of CPAP on stroke incidence in OSA patients. Methods Using Taiwan's National Health Insurance Research Database (NHIRD), this study collected data from 4275 OSA patients diagnosed between 2000 and 2011 and divided them into two groups according to whether they received CPAP treatment. After matching baseline demographics and comorbidities, both cohorts contained 959 OSA patients and were followed to a newly diagnosed stroke or until the end of 2013. Cox regression analysis was performed to examine the incidence of stroke between patients with OSA receiving CPAP or no CPAP treatment. Results CPAP treatment for OSA patients predicted a lower incidence rate (3.41 vs 5.43 per 1000 person‐years) and tended to protect against the development of stroke (hazard ratio (HR): 0.68, 95% confidence interval (95% CI): 0.38‐1.23) compared to those without CPAP treatment, but the estimate was not statistically significant. Similar results were also observed by dividing stroke into ischemic (2.65 vs 4.30 per 1000 person‐years; HR: 0.67, 95% CI: 0.35‐1.31) or hemorrhagic origin (0.76 vs 1.12 per 1000 person‐years; HR: 0.67, 95% CI: 0.19‐2.40). Conclusions It is possible that treatment with CPAP might be beneficial for protection against stroke, but this conclusion should be interpreted with caution. Future studies with satisfactory CPAP quality and duration are needed to validate this observation.