Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression
Source : https://err.ersjournals.com/content/32/167/220169
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.
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.
• Source: European Respiratory Review
• Conclusions “Post-stroke patients with SDB [sleep-disordered breathing] benefited from PAP [positive airway pressure] therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.”
• In the current meta-analysis, international researchers included 24 studies that demonstrated that PAP therapy decreased recurrent vascular events, cognition, deficit, functional independence, depression, and daytime sleepiness.
• PAP therapy decreased recurrent vascular events (risk ratio ), as well as yielding significant beneficial effects on cognition, neurological deficit, functional independence, cognition, and daytime sleepiness. Depression only trended lower. No significant publication bias was detected.
• Limitations of the current study include heterogeneous secondary outcomes across studies and the fact that Chinese studies included lacked detailed reporting and were not reproducible.
• “Based on the findings of this review, institutions should consider treating post-stroke SDB patients with PAP therapy to reduce recurrent vascular events risk and improve the prospect of recovery in other health outcomes. Potential health benefits heavily outweigh any risk or adverse effect and improved outcomes were found in patients with mild-to-moderate SDB treated in the non-acute phase of the stroke. Compliance is crucial and at least 4 h of usage per night should be reinforced until further studies ascertain an optimal usage duration,” the authors recommended.