Abstract
BackgroundSleep 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.MethodsWe 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.ResultsWe 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.ConclusionsPost-stroke patients with SDB benefited from PAP therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.
Publisher
European Respiratory Society (ERS)
Subject
Pulmonary and Respiratory Medicine