The role of obstructive sleep apnea, neurofilaments and early CPAP intervention in post-stroke cognitive recovery

Q1 Medicine

Sleep Medicine: X Pub Date : 2025-05-31 DOI:10.1016/j.sleepx.2025.100142

Petra Levicka , Miriam Slavkovska , Dominik Koren , Joaquim Ventosa , Ján Hlodak , Jana Papikova , Zuzana Gdovinova , Eva Feketeova

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Abstract

Stroke is a leading cause of disability worldwide, with cognitive impairment following stroke influenced by a complex interplay of modifiable and non-modifiable risk factors.

This study investigated the impact of obstructive sleep apnea (OSA) on cognitive outcomes after ischemic stroke (IS) and the predictive value of plasma neurofilament light chain (pNFL) levels. Seventy-three acute IS patients were analyzed, with 59 completing a three-month follow-up. Cognitive function (Montreal Cognitive Assessment, MoCA) was assessed. Patients underwent polygraphic screening for OSA in the acute phase, with treatment recommended when indicated, and pNFL levels measured at baseline and follow-up.

Results showed that 93.2 % of IS patients had OSA. Forty (72.7 %) of OSA patients (moderate, severe OSA) were recommended continuous positive airway pressure (CPAP). CPAP-treated patients in the acute phase demonstrated cognitive improvement at three-month follow-up (CPAP-treated: MoCA 23 vs 25 points, CPAP indicated untreated, MoCA 22 vs 22 points, p = 0.05). However, long-term adherence to CPAP was poor - only 25 % remained on therapy at three months. While pNFL levels correlated with infarct volume and significantly decreased over time, no correlation was found between OSA severity and CPAP treatment. Regression analysis identified age, prior stroke history, and anxiety as key predictors of cognitive and functional post-stroke outcome.

Early CPAP therapy could contribute to improved post-stroke cognitive performance. Decline in pNFL levels shows ongoing neuronal recovery; a direct relationship with OSA is inconclusive. Furthermore, advanced age, history of prior stroke, and anxiety symptoms emerged as significant contributors to poorer cognitive outcomes.

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阻塞性睡眠呼吸暂停、神经丝和早期CPAP干预在脑卒中后认知恢复中的作用

中风是世界范围内致残的主要原因，中风后的认知障碍受到可改变和不可改变的危险因素的复杂相互作用的影响。本研究探讨阻塞性睡眠呼吸暂停（OSA）对缺血性卒中（IS）后认知结局的影响及血浆神经丝轻链（pNFL）水平的预测价值。对73名急性IS患者进行了分析，其中59人完成了为期3个月的随访。认知功能（Montreal Cognitive Assessment, MoCA）评估。患者在急性期接受了OSA的多涂片筛查，有必要时推荐治疗，并在基线和随访时测量pNFL水平。结果显示，93.2%的IS患者存在OSA。40例（72.7%）OSA患者（中度、重度OSA）推荐持续气道正压通气（CPAP）。急性期接受CPAP治疗的患者在三个月的随访中表现出认知改善（CPAP治疗：MoCA 23分vs 25分，CPAP未治疗，MoCA 22分vs 22分，p = 0.05）。然而，CPAP的长期依从性很差，只有25%的患者在3个月时仍坚持治疗。虽然pNFL水平与梗死面积相关，且随时间显著降低，但OSA严重程度与CPAP治疗之间未发现相关性。回归分析发现，年龄、既往卒中史和焦虑是卒中后认知和功能预后的关键预测因素。早期CPAP治疗有助于改善脑卒中后的认知能力。pNFL水平下降表明神经元正在恢复；与OSA的直接关系尚无定论。此外，高龄、既往中风史和焦虑症状是导致认知结果较差的重要因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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