Continuous positive airway pressure with good adherence can reduce risk of stroke in patients with moderate to severe obstructive sleep apnea: An updated systematic review and meta-analysis
Jan Huan Lin, MD 1 , Hao Jen Yeh, MD 2 , Tsang Meng Hsieh, MD 1, 3 ,
1 Department of Neurology, E-DA hospital/I-shou University
2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Da-Chung Branch
3 Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
Yao Chung Hsu , MD
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Obstructive sleep apnea (OSA), an independent risk factor for stroke, is frequently overlooked in current stroke care and polysomnography is not regularly performed. The continuous positive airway pressure (CPAP) treatment is the gold standard treatment for moderate and severe OSA. Thus, we systematically reviewed all the available literature and performed this meta-analysis to evaluate the effect of CPAP for preventing stroke.
MATERIAL and METHOD:
Embase, PubMed, and Cochrane Central database were searched for studies that compared stroke risk in patients with OSA receiving CPAP or usual treatment. Eighteen articles were considered relevant after the first level of evaluation. Further, we excluded five cohort studies: three due to mixed outcomes of stroke and coronary artery disease (CAD) and two from the administrative database due to undefinable stroke events. Consequently, 13 studies, involving 7379 participants, with nine randomized control trials (RCTs) and four cohort studies, were selected for final analysis.
We separately performed meta-analysis of RCTs and cohort studies due to different study design. The meta-analysis of cohort studies revealed significant stroke risk reduction , while the result in RCTs was not significant. In the subgroup analysis of RCTs, it showed significant stroke risk reduction in good CPAP adherence group but not in varied adherence group. The stroke risk reduction was significant in moderate to severe OSA degree group but not in mixed OSA degree group.
According to our knowledge, this is the first meta-analysis evaluating the effect of CPAP for preventing stroke. Although the overall effect was contradicting between RCTs and cohort studies, the subgroup analysis of RCTs revealed a significant stroke risk reduction in good CPAP adherence status and patients with moderate to severe degree of OSA. Further researches should focus on improving CPAP adherence in patients with stroke