Effectiveness and feasibility of continuous positive airway pressure in patients with stroke and sleep apnea: a meta-analysis of randomized trials

This meta-analysis found that CPAP therapy is feasible in patients with early- and late-onset stroke complicated by SA, and CPAP may improve neurological outcomes. This study supported further research in this area. This meta-analysis included 14 RCTs that evaluated the effect of CPAP compared with that of usual treatment in patients with stroke or TIA with SA. Compared with the previous studies, our study added functional status as a primary outcome measure, and the results showed that current data are insufficient to conclude that CPAP improves functional outcomes in patients with stroke and SA. Despite a trend of lower risk for recurrent vascular events in CPAP-treated patients, the difference was not significant. Additionally, there was no improvement in cognitive function, depression, and sleepiness after CPAP intervention.

With regard to the feasibility of CPAP therapy, our result showed that the mean duration of CPAP use was 4.47 hours/night, and the adherence was acceptable. These findings are similar to those presented in a previous meta-analysis published by Brill et al. The dropout rate was 12.41% (70/564) in the intervention group and 8.18% (41/501) in the control group. It was higher in the experimental group but did not differ significantly from that in the control group. CPAP therapy was safe, and no serious adverse events related to the intervention were reported in any of the trials. The non-serious adverse events related to the face mask were more common in the CPAP group and mainly included local irritation of the skin or mucosa and symptoms such as sneezing and nasal irritation. The above results indicated that CPAP therapy is feasible in patients with stroke and SA. However, this result needs to be interpreted cautiously due to the high heterogeneity among the included studies.

https://jcsm.aasm.org/doi/full/10.5664/jcsm.10680