Obstructive sleep apnea is under-diagnosed, under-reported and therefore under-treated in patients after a stroke. The aim of this meta-analysis of Randomized Control Trials (RCTs) was to investigate the effectiveness of positive airway treatment on recurrent vascular events, neurological deficit, functional independence, depression, sleepiness and cognitive function in patients post-stroke.

Records identified from Embase Elsevier Database (Embase, Medline/PubMed, Preprints, PubMed-not-Medline) were searched from inception in July 2024, up to September 2024. After screening 72387 records, 21 RCTs were included with 1457 patients with stroke. Out of these 753 patients were in the PAP arm and 704 in the conventional arm.

Metanalysis showed that PAP treatment reduced recurrent vascular events OR 0.45, (95 % Confidence Interval (CI) 0.28 to 0.78; p < 0.01), improved neurological deficit OR -0.30, (95 % CI -0.47 to −0.14; p < 0.01), reduced daytime sleepiness OR: −0.96, (95 % CI -1.47 to −0.45; p < 0.01), improved depression levels; OR: −0.58, (95 % CI -1.05 to −0.11; p = 0.02), improved cognitive function; OR1.10; (95 % CI 0.35 to 1.86; p = 0.02), but did not improve functional independence OR 0.25, (95 % CI -0.11 to 0.60; p = 0.17)

Therefore, positive airway pressure treatment is effective in patients with stroke and can reduce recurrent vascular events and improve recovery of these patients.