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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials
Neurology, Volume 90, No. 14, Year 2018
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Description
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. © 2018 American Academy of Neurology.
Authors & Co-Authors
Haynes, Alan G.
Brazil, Sao Paulo
Universidade de São Paulo
Egger, Matthias
Brazil, Sao Paulo
Universidade de São Paulo
Bassetti, Claudio L.A.
Brazil, Sao Paulo
Universidade de São Paulo
Statistics
Citations: 68
Authors: 3
Affiliations: 1
Identifiers
Doi:
10.1212/WNL.0000000000005262
ISSN:
1526632X
Research Areas
Genetics And Genomics
Noncommunicable Diseases
Study Design
Randomised Control Trial
Study Approach
Systematic review