Sleep apnea is associated with increased risk for mortality,302 and risk factors including Sleep apnea affects 38% to 40% (AHI >20) of patients with stroke, with >90% of cases being OSA rather than central sleep Limited data suggest that patients with acute ischemic stroke and OSA are at increased risk for func- tional impairment, stroke recurrence, and death, although causation is not established.314,327 329 Limited data from small trials show that treatment with CPAP is safe after stroke, reduces the AHI, improves sleepiness, and may improve neurological function.304 311 Effects on vascular recurrence are uncertain, although a planned ancillary analysis in the SAVE study (Sleep Apnea Cardiovascular Endpoints) revealed that risk for stroke was lower among participants (all had a history of coronary artery disease or cerebrovascular disease) who had better adherence to CPAP therapy (HR, 0.56 [95% CI, 0.32 1.00]). Recommendation-Specific Supportive Text 1. Our recommendation to treat patients with OSA using CPAP is consistent with a guideline from the American College of Physicians that recom- mends CPAP as the initial therapy.330 In stud- ies of various populations, treatment with CPAP effectively reduced the AHI and improved mea- sures of sleepiness, BP control, sleep-related quality of life, and physical functioning.302,303 As described in the above synopsis, limited data from small trials specifically among patients with stroke show that treatment with CPAP is CLINICAL STATEMENTS AND GUIDELINES Kleindorfer safe, reduces the AHI, improves sleepiness, and may improve neurological function.304 313 Evidence from 1 trial suggests that treat- ment may improve mood.314 In a planned ancil- lary analysis in the SAVE trial, which enrolled patients with either coronary or cerebrovascu- lar disease, CPAP reduced the risk for stroke in patients with better CPAP adherence.303 The American College of Physicians recommends mandibular advancement devices as an alterna- tive for patients who do not tolerate CPAP or who prefer mandibular advancement.330 These devices, however, have not been specifically tested in patients with stroke. 