CPAP as treatment of sleep apnea after stroke A meta-analysis of randomized trials
CPAP as treatment of sleep apnea after stroke A meta-analysis of randomized trials
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DOI：
10.1212/wnl.0000000000005262
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发表时间：
2018-04-03
期刊：
影响因子：
9.9
通讯作者：
Bassetti, Claudio L.
中科院分区：
文献类型：
--
作者：
Brill, Anne-Kathrin;Horvath, Thomas;Bassetti, Claudio L.
目的 对随机对照试验 (RCT) 进行系统回顾和荟萃分析，研究持续气道正压通气 (CPAP) 对伴有睡眠呼吸障碍 (SDB) 的中风患者的有效性。方法通过对 1980 年至 2016 年 11 月电子数据库（MEDLINE、Embase 和 Cochrane 图书馆）的系统文献检索，我们确定了随机对照试验 (RCT)，这些随机对照试验对患有睡眠呼吸障碍 (SDB) 的成人中风或 TIA 患者评估 CPAP 与标准护理或假 CPAP 进行比较。深圳发展银行。计算平均 CPAP 使用率、比值比 (OR) 和标准化平均差 (SMD)。预先设定的结果包括坚持 CPAP 治疗、神经功能改善、不良事件、新血管事件和死亡。 结果 纳入 10 项以 CPAP 为干预措施的随机对照试验（564 名受试者）。两项研究比较了 CPAP 与假 CPAP； 8 将 CPAP 与常规护理进行了比较。整个试验中 CPAP 平均使用时间为每晚 4.53 小时（95% 置信区间 [CI] 3.97-5.08）。退出 CPAP 治疗的 OR 为 1.83 (95% CI 1.05-3.21, p = 0.033)。神经功能量表（NIH 卒中量表和加拿大神经病学量表）的综合分析显示，CPAP 治疗后神经功能总体得到改善（SMD 0.5406，95% CI 0.0263-1.0548），但各研究之间存在相当大的异质性（I-2 = 78.9%，p = 0.0394）。在一项试验中，CPAP 可以改善长期生存。结论：一旦治疗耐受，中风后使用 CPAP 是可以接受的。数据表明，CPAP 可能有益于神经系统恢复，这证明了更大的随机对照试验的合理性。
ObjectiveTo perform a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effectiveness of continuous positive airway pressure (CPAP) in stroke patients with sleep disordered breathing (SDB).MethodsIn a systematic literature search of electronic databases (MEDLINE, Embase, and the Cochrane Library) from 1980 to November 2016, we identified RCTs that assessed CPAP compared to standard care or sham CPAP in adult patients with stroke or TIA with SDB. Mean CPAP use, odds ratios (ORs), and standardized mean differences (SMDs) were calculated. The prespecified outcomes were adherence to CPAP, neurologic improvement, adverse events, new vascular events, and death.ResultsTen RCTs (564 participants) with CPAP as intervention were included. Two studies compared CPAP with sham CPAP; 8 compared CPAP with usual care. Mean CPAP use across the trials was 4.53 hours per night (95% confidence interval [CI] 3.97-5.08). The OR of dropping out with CPAP was 1.83 (95% CI 1.05-3.21, p = 0.033). The combined analysis of the neuro-functional scales (NIH Stroke Scale and Canadian Neurological Scale) showed an overall neurofunctional improvement with CPAP (SMD 0.5406, 95% CI 0.0263-1.0548) but with a considerable heterogeneity (I-2 = 78.9%, p = 0.0394) across the studies. Long-term survival was improved with CPAP in 1 trial.ConclusionCPAP use after stroke is acceptable once the treatment is tolerated. The data indicate that CPAP might be beneficial for neurologic recovery, which justifies larger RCTs.