持续气道正压通气治疗脑卒中合并睡眠呼吸暂停患者的有效性和可行性：一项随机试验的荟萃分析。

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

机构信息

Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Department of Rehabilitation Medicine, People's Hospital of Chongqing Banan District, Chongqing, China.

出版信息

J Clin Sleep Med. 2023 Sep 1;19(9):1685-1696. doi: 10.5664/jcsm.10680.

DOI:10.5664/jcsm.10680

PMID:37664950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10476038/

Abstract

STUDY OBJECTIVES

This meta-analysis aimed to investigate the feasibility and effectiveness of continuous positive airway pressure (CPAP) treatment in stroke patients with sleep apnea.

METHODS

PubMed, EMBASE, and the Cochrane Library were searched from inception until July 28, 2022, for randomized controlled trials comparing the use of CPAP and usual treatment in patients with stroke or transient ischemic attack and sleep apnea. The primary outcome measures were the feasibility of CPAP therapy, neurological function, and functional status.

RESULTS

After screening 5,747 studies, 14 studies with 1,065 patients were included in this meta-analysis. Overall, 8 of the 14 studies recorded CPAP use, and the mean CPAP use was 4.47 hours per night (95% confidence interval [CI]: 3.85-5.09). The risk ratio of discontinuing CPAP was 1.50 (95% CI: 0.76-2.94; = .24). Analysis of the neurofunctional scales showed that CPAP treatment improved neurological function (standardized mean difference: 0.28; 95% CI: 0.02-0.53), but there was substantial heterogeneity ( = 57%, = .03) across the studies. CPAP treatment had no significant effect on functional status vs the control (standardized mean difference: 0.25; 95% CI: -0.01 to 0.51), but the studies also had substantial heterogeneity ( = 55%, = .06).

CONCLUSIONS

CPAP treatment is feasible in patients with stroke and sleep apnea and may improve neurological outcomes in these patients. However, this finding should be interpreted with caution because of the substantial heterogeneity of current trials.

CITATION

Fu S, Peng X, Li Y, Yang L, Yu H. Effectiveness and feasibility of continuous positive airway pressure in patients with stroke and sleep apnea: a meta-analysis of randomized trials. . 2023;19(9):1685-1696.

摘要

目的

本荟萃分析旨在研究持续气道正压通气（CPAP）治疗睡眠呼吸暂停的脑卒中患者的可行性和疗效。

方法

从建库至 2022 年 7 月 28 日，检索 PubMed、EMBASE 和 Cochrane Library 中比较 CPAP 治疗与常规治疗在脑卒中或短暂性脑缺血发作合并睡眠呼吸暂停患者中的应用的随机对照试验。主要结局指标为 CPAP 治疗的可行性、神经功能和功能状态。

结果

经过筛选 5747 项研究，14 项研究共纳入 1065 例患者纳入本荟萃分析。总体而言，14 项研究中有 8 项记录了 CPAP 的使用情况，平均每晚 CPAP 使用时间为 4.47 小时（95%置信区间：3.85-5.09）。CPAP 治疗中断的风险比为 1.50（95%置信区间：0.76-2.94； =.24）。对神经功能量表的分析表明，CPAP 治疗可改善神经功能（标准化均数差：0.28；95%置信区间：0.02-0.53），但研究间存在较大异质性（ = 57%， =.03）。CPAP 治疗与对照组相比对功能状态无显著影响（标准化均数差：0.25；95%置信区间：-0.01 至 0.51），但研究间也存在较大异质性（ = 55%， =.06）。