• Georgios Tsivgoulis, Andrei V Alexandrov, Aristeidis H Katsanos, Kristian Barlinn, Robert Mikulik, Vaia Lambadiari, Anastasios Bonakis, and Anne W Alexandrov.
• From the Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.V.A., A.W.A.); Second Department of Neurology (G.T., A.H.K., A.B.) and Second Department of Internal Medicine (V.L.),"Attikon" University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology, Carl Gustav Carus Hospital Dresden, Germany (K.B.); and International Clinical Research Center, Neurology Department, St Anne's Hospital and Masaryk University, Brno, Czech Republic (R.M.). tsivgoulisgiorg@yahoo.gr.
• Stroke. 2017 Aug 1; 48 (8): 2285-2288.

Background And PurposeEven though current guidelines suggest that noninvasive ventilatory correction (NIVC) could be considered for acute ischemic stroke patients with obstructive sleep apnea, available evidence is conflicting, with no adequately powered randomized clinical trial being available to date.MethodsWe conducted a systematic review and meta-analysis of all available literature data evaluating the effect of NIVC on neurological improvement (based on decrease in National Institutes of Health Stroke Scale score), vascular events (recurrent stroke, transient ischemic attack, myocardial infarction and unstable angina), and mortality during the follow-up period.ResultsWe identified 4 randomized clinical trials and 1 prospectively matched observational cohort, comprising a total of 389 patients (59.8% males, mean age: 64.4 years). The risk of both performance and detection bias was considered high in most of the included randomized clinical trials because of the lack of blinding in participants, personnel and/or outcome assessors. The mean decrease in National Institutes of Health Stroke Scale scores during the first (≤30) days of acute ischemic stroke was found to be greater in NIVC-treated patients in comparison to controls (standardized mean difference, 0.38; 95% confidence interval, 0.11-0.66; P=0.007). However, no significant differences were detected between NIVC-treated acute ischemic stroke patients and controls on both the risk of vascular events (risk ratio, 0.53; 95% confidence interval, 0.25-1.14; P=0.11) and mortality (risk ratio, 0.71; 95% confidence interval, 0.37-1.36; P=0.30). No evidence of heterogeneity (I2=0%; P for Cochran Q>0.50) or publication bias were detected in all analyses.ConclusionsNIVC seems to be associated with greater short-term neurological improvement in acute ischemic stroke patients with obstructive sleep apnea. This finding deserves further investigation within the settings of an adequately powered, sham-control, randomized clinical trial.© 2017 American Heart Association, Inc.

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