Effect of continuous positive airway pressure therapy on stroke risk and rehabilitation in population with obstructive sleep apnea: A PRISMA-compliant systematic review and meta-analysis

Background: Previous studies reported inconsistent results regarding the effect of continuous positive airway pressure (CPAP) therapy on stroke risk and rehabilitation in population with obstructive sleep apnea (OSA). The present study aimed to make a meta-analysis to explore the effect of CPAP therapy on stroke risk and rehabilitation in OSA. Methods: Articles published in English before March 2021 in the databases as follows: PubMed, Medline, Web of Science, EMBASE and Google Scholar. For the effect of CPAP therapy on risk of stroke. We computed the results of relative risk (RR) or hazard ratio (HR) and 95% confidence intervals (Cis) regarding the effect of CPAP therapy on risk of stroke. For the effect of CPAP therapy on stroke rehabilitation, the standardized mean differences (SMD) in change rates of National Institute of Health stroke scale (NIHSS) or Canadian Neurological Scale (CNS) scores with a 95% CI was obtained with STATA 12.0 software to estimate the treatment effect. Results: The study indicated no significant effect of CPAP therapy on stroke risk in patients with OSA (RR/HR = 0.67. 95% CI 0.39 to 1.16, I-2 = 84.1%, p < 0.001). However, the study showed a better neurological outcome in OSA patients with stroke treated with CPAP plus usual care. compared to those treated with usual-care (SMD = 0.45, 95% CI 0.03 to 0.87, I-2 = 73.9%, p = 0.001). Conclusion: The present study showed that CPAP therapy did not prevent stroke in patients with OSA. However, the study showed a neurofunctional improvement with CPAP therapy in OSA patients with stroke.