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CPAP as treatment of sleep apnea after strokeA meta-analysis of randomized trials

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Brill Anne-Kathrin, Horvath Thomas, Seiler Andrea, Camilo Millene, Haynes Alan G., Ott Sebastian R., Egger Matthias, Bassetti Claudio L.,
Project Forschungspauschale Forschungsratspräsident SNF
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Original article (peer-reviewed)

Journal Neurology
Volume (Issue) 90(14)
Page(s) e1222 - e1230
Title of proceedings Neurology
DOI 10.1212/wnl.0000000000005262

Open Access

URL https://boris.unibe.ch/113079/7/Brill%20Neurology%202018.pdf
Type of Open Access Repository (Green Open Access)

Abstract

ObjectiveTo perform a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effectiveness of continuous positive airway pressure (CPAP) in stroke patients with sleep disordered breathing (SDB).MethodsIn a systematic literature search of electronic databases (MEDLINE, Embase, and the Cochrane Library) from 1980 to November 2016, we identified RCTs that assessed CPAP compared to standard care or sham CPAP in adult patients with stroke or TIA with SDB. Mean CPAP use, odds ratios (ORs), and standardized mean differences (SMDs) were calculated. The prespecified outcomes were adherence to CPAP, neurologic improvement, adverse events, new vascular events, and death.Results Ten RCTs (564 participants) with CPAP as intervention were included. Two studies compared CPAP with sham CPAP; 8 compared CPAP with usual care. Mean CPAP use across the trials was 4.53 hours per night (95% confidence interval [CI] 3.97–5.08). The OR of dropping out with CPAP was 1.83 (95% CI 1.05–3.21, p = 0.033). The combined analysis of the neurofunctional scales (NIH Stroke Scale and Canadian Neurological Scale) showed an overall neurofunctional improvement with CPAP (SMD 0.5406, 95% CI 0.0263–1.0548) but with a considerable heterogeneity ( I2 = 78.9%, p = 0.0394) across the studies. Long-term survival was improved with CPAP in 1 trial. ConclusionCPAP use after stroke is acceptable once the treatment is tolerated. The data indicate that CPAP might be beneficial for neurologic recovery, which justifies larger RCTs.
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