Background: The impact of sleep apnea (SA) and continuous positive airway pressure (CPAP) treatment on post-stroke sleepiness are poorly described. To compare through a propensity score matching the trajectories of self-reported sleepiness post-stroke with matched individuals including sleep apnea patients adherent or not to continuous positive airway pressure (CPAP). 

Methods: 65(80.2%) ischemic stroke and 16(19.8%) TIA patients (median[Q1;Q3] age=67.0[58.0;74.0] years, 70.4% male, body mass index=26.1[24.5;29.8] kg/m2, NIHSS score at admission=3.0[1.0;5.0]), with a polysomnography and an Epworth Sleepiness Scale (ESS) performed within one year following stroke and with a follow-up ESS (delay=236[147;399] days) were included in the analysis. A 2:1 propensity score matching based on age, gender, body mass index, and apnea-hypopnea index was performed to identify 162 matched individuals referred for sleep apnea suspicion, free of stroke or TIA. Multivariable negative binomial regression models were performed to identify the determinants of self-reported sleepiness trajectories post-stroke. 

Results: Twenty-one (25.9%) stroke/TIA patients presented excessive daytime sleepiness (ESS>10/24) at baseline compared to 52(32.1%) control patients (p=0.37). The range of improvement in ESS was higher in stroke patients compared to controls (median[Q1;Q3] ?ESS=-2[-4;1] vs. 0[-3;2], p=0.01). In multivariable analysis, comorbid SA and CPAP treatment had no influence on trajectories of sleepiness post-stroke.

Conclusions: Sleepiness improvement was unexpectedly higher in stroke patients compared to matched individuals, with no significant influence of comorbid SA and CPAP treatment on its trajectory.