The use of continuous positive airway pressure (CPAP) is an effective treatment for sleep-disordered breathing in patients who have experienced a stroke, according to the results of a systematic review and meta-analysis of randomized controlled trials (RCTs) published recently in Neurology.
The investigators conducted a systematic search of reports published between January 1980 and November 2016 to identify RCTs that compared CPAP with sham CPAP or usual care to treat sleep-disordered breathing in adults following a transient ischemic attack or stroke. Prespecified study outcomes included adherence to CPAP, neurologic improvement, new vascular events, adverse events, or death.
A total of 10 RCTs with 564 participants, in which CPAP was used as the intervention, were included in the analysis. Of the 10 RCTs, 2 compared CPAP with sham CPAP and 8 compared CPAP with usual care. The mean CPAP use across the studies was 4.53 hours per night (95% CI, 3.97-5.08) but with considerable heterogeneity (P <.0001) across the trials.
Dropouts and adherence with CPAP use were assessed in all the trials. Rates of dropout ranged from 0% to 46%, with more dropouts reported in the CPAP groups than in the sham CPAP or usual care groups. The combined odds ratio of dropping out was 1.93 (95% CI, 1.05-3.21; P =.033), with no between-study heterogeneity reported.
The combined analysis of the neurofunctional scales (National Institutes of Health Stroke Scale and Canadian Neurological Scale) demonstrated an overall neurofunctional improvement with CPAP (standardized mean difference 0.5406; 95% CI, 0.0263-1.0548) but with considerable heterogeneity (P =.0394) across the studies. In 1 trial, long-term survival was improved with the use of CPAP.
The investigators concluded that CPAP use following a stroke is an acceptable method once the treatment has been tolerated. With the data demonstrating that CPAP might be beneficial for neurologic recovery, additional RCTs with well-predefined outcomes that include a larger number of patients and focus on imaging methods are warranted.
Brill AK, Horvath T, Seiler A, et al. CPAP as treatment of sleep apnea after stroke: a meta-analysis of randomized trials. Neurology. 2018;90(14):e1222-e1230.