CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials.
- Brill AK From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
- Horvath T From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
- Seiler A From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
- Camilo M From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
- Haynes AG From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
- Ott SR From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
- Egger M From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
- Bassetti CL From the Department of Pulmonary Medicine (A.-K.B., S.R.O.), Department of Neurology (T.H., A.S., M.C., C.L.B.), and Sleep Wake Epilepsy Center (A.-K.B., T.H., A.S., M.C., S.R.O., C.L.B.), Inselspital, University Hospital Bern, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, University of São Paulo, Brazil; and CTU Bern (A.G.H.) and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland. claudio.bassetti@insel.ch.
- 2018-03-11
Published in:
- Neurology. - 2018
Continuous Positive Airway Pressure
Humans
Randomized Controlled Trials as Topic
Sleep Apnea Syndromes
Stroke
English
OBJECTIVE
To 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).
METHODS
In 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.
CONCLUSION
CPAP 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.
To 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).
METHODS
In 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.
CONCLUSION
CPAP 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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1212/WNL.0000000000005262
- PMID 29523641
- Persistent URL
- https://sonar.ch/global/documents/247434
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