1. Positive airway pressure therapy for post-stroke sleep disordered breathing:a systematic review, meta-analysis and meta-regression
- Author
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Toh, Z. A. (Zheng An), Cheng, L. J. (Ling Jie), Wu, X. V. (Xi Vivien), De Silva, D. A. (Deidre Anne), Oh, H. X. (Hui Xian), Ng, S. X. (Si Xian), He, H.-G. (Hong-Gu), Pikkarainen, M. (Minna), Toh, Z. A. (Zheng An), Cheng, L. J. (Ling Jie), Wu, X. V. (Xi Vivien), De Silva, D. A. (Deidre Anne), Oh, H. X. (Hui Xian), Ng, S. X. (Si Xian), He, H.-G. (Hong-Gu), and Pikkarainen, M. (Minna)
- Abstract
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.
- Published
- 2023