CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials.

Brill, Anne-Kathrin; Horvath, Thomas; Seiler, Andrea; Camilo, Millene; Haynes, Alan G; Ott, Sebastian R; Egger, Matthias; Bassetti, Claudio (2018). CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials. Neurology, 90(14), e1222-e1230. Lippincott Williams & Wilkins 10.1212/WNL.0000000000005262

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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,= 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 (= 78.9%,= 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Brill, Anne-Kathrin; Horvath, Thomas; Seiler, Andrea Barbara; Haynes, Alan; Ott, Sebastian Robert; Egger, Matthias and Bassetti, Claudio

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

22 Mar 2018 11:37

Last Modified:

21 Sep 2018 09:21

Publisher DOI:

10.1212/WNL.0000000000005262

PubMed ID:

29523641

Additional Information:

Brill, Horvath and Seiler contributed equally to this work

BORIS DOI:

10.7892/boris.113079

URI:

https://boris.unibe.ch/id/eprint/113079

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