Effectiveness of continuous positive airway pressure therapy on apnea-related outcomes in stroke patients with obstructive sleep apnea: a systematic review and meta-analysis of randomized controlled trials

Abstract

Continuous Positive Airway Pressure (CPAP) therapy is the first-line treatment for obstructive sleep apnea (OSA). However, its effectiveness on apnea-related outcomes in stroke patients with OSA remains unclear. While several studies have investigated CPAP in this population, randomized controlled trials (RCTs) have not consistently shown significant neurological benefits. Therefore, we conducted a meta-analysis of RCTs evaluating the effect of CPAP on apnea-related outcomes in patients with stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) and concomitant OSA, compared with usual care or sham CPAP. We searched The Cochrane Library, PubMed, and EMBASE for relevant studies. Studies were included if more than 70% of participants were diagnosed with OSA. Outcomes of interest were apnea-hypopnea index (AHI), sleepiness, stroke recurrence, all-cause mortality, depression, quality of life, neurological function severity, activities of daily living (ADL), and functional independence. A total of nine studies with 671 patients were included, of whom 366 patients (54.5%) received CPAP. The studies had follow-up periods ranging from three weeks to two years. Patients who received CPAP treatment had significantly reduced AHI (MD -16.32; 95% CI –22.78 to –9.86; p<0.00001) and sleepiness values (MD -1.64; 95% CI –3.21 to –0.06; p=0.04). The incidences of stroke recurrence (including TIA) (RR 0.77; 95% CI 0.35 to1.68; p=0.51) and all-cause mortality (RR 0.81; 95% CI 0.29 to 2.30; p=0.70) were reduced in the CPAP group, but the results were not statistically significant. Neurological function severity (MD -0.50; 95% CI –1.04 to 0.04; p=0.07) showed a reduction in the CPAP group; however, this did not reach statistical significance. Activities of daily living (MD 0.24; 95% CI –3.05 to 3.53; p=0.89) improved in the 3-week to 3-month window in CPAP group, but the change was not statistically significant; a similar pattern (MD 0.39; 95% CI –3.24 to 4.02; p=0.83) was observed at 12 months. Functional independence (MD –0.37; 95% CI –0.61 to –0.14; p=0.002) was significantly improved in CPAP group. In conclusion, compared with usual care or sham-CPAP, CPAP treatment in stroke patients with OSA was associated with reductions in AHI and sleepiness, as well as improvements in functional independence.