University of Oulu

Toh ZA, Cheng LJ, Wu XV, et al. Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression. Eur Respir Rev 2023; 32: 220169 [DOI: 10.1183/16000617.0169-2022]

Positive airway pressure therapy for post-stroke sleep disordered breathing : a systematic review, meta-analysis and meta-regression

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Author: Toh, Zheng An1,2,3; Cheng, Ling Jie3,4; Wu, Xi Vivien1,3;
Organizations: 1Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
2Division of Nursing, National University Hospital, Singapore
3National University Health System, Singapore
4Saw Swee Hock School of Public Health, National University of Singapore, Singapore
5Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
6Department of Occupational Therapy, Prosthetics and Orthoptics, Faculty of Health Sciences and Department of Product Design, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
7Martti Ahtisaari Institute, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: European Respiratory Society, 2023
Publish Date: 2023-09-04


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.

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Series: European respiratory review
ISSN: 0905-9180
ISSN-E: 1600-0617
ISSN-L: 0905-9180
Volume: 32
Article number: 22016
DOI: 10.1183/16000617.0169-2022
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This study was funded by Business Finland, Finland (grant 2668/31/2019). Funding information for this article has been deposited with the Crossref Funder Registry.
Copyright information: © The authors 2023. This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact