Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression

Journal article

Background

Sleep disordered breathing (SDB) is an under-recognised independent risk factor and a potential consequence of stroke. We systematically reviewed and meta-analysed the effectiveness of positive airway pressure (PAP) therapy in improving post-stroke outcomes.

Methods

We searched CENTRAL, Embase, PubMed, CINAHL, PsycINFO, Scopus, ProQuest, Web of Science and CNKI (China National Knowledge Infrastructure) for randomised controlled trials comparing PAP therapy against a control or placebo group. We evaluated the pooled effects of PAP therapy on recurrent vascular events, neurological deficit, cognition, functional independence, daytime sleepiness and depression using random effects meta-analyses.

Results

We identified 24 studies. Our meta-analyses showed that PAP therapy reduced recurrent vascular events (risk ratio 0.47, 95% CI 0.28-0.78), and showed significant beneficial effects on neurological deficit (Hedges' g= -0.79, 95% CI -1.19- -0.39), cognition (g=0.85, 95% CI 0.04-1.65), functional independence (g=0.45, 95% CI 0.01-0.88) and daytime sleepiness (g= -0.96, 95% CI -1.56- -0.37). However, there was insignificant reduction in depression (g= -0.56, 95% CI -2.15-1.02). No publication bias was detected.

Conclusions

Post-stroke patients with SDB benefited from PAP therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.

Authors: Toh, ZA; Cheng, LJ; Wu, XV; De Silva, DA; Oh, HX

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: European Respiratory Society
• Journal: European Respiratory Review
• Volume: 32
• Issue: 167
• Pages: 220169-220169
• Publication date: 2023-03-08
• DOI: 10.1183/16000617.0169-2022
• EISSN: 1600-0617
• ISSN: 0905-9180
• Language: English
• Keywords: Sleep disorder; Depression (economics); Randomized controlled trial; Internal medicine; Meta-analysis; Stroke (engine); Obstructive sleep apnea; Psychiatry; Excessive daytime sleepiness; Physical therapy; Medicine; Positive airway pressure; Cognition; Continuous positive airway pressure