Evidence map›Paper›PMID 33870178›Full record

ArticleSleep medicine: X2020

SAS CARE 2 - a randomized study of CPAP in patients with obstructive sleep disordered breathing following ischemic stroke or transient ischemic attack.

C Bernasconi, S R Ott, F Fanfulla, S Miano, T Horvath, A Seiler, C W Cereda, A-K Brill, P Young, L Nobili and 3 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Sleep medicine: X, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 4 pooled it
1.3field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 4 syntheses or guidelines pooled it, 15 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression.European respiratory review : an official journal of the European Respiratory Society · 2023
    Pooled it
  5. Review
  6. Review
  7. Article
  8. Review
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 4 countries.

C BernasconiDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
S R OttDepartment of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
F FanfullaSleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.
S MianoSleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.
T HorvathDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
A SeilerDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
C W CeredaStroke Center EOC, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.
A-K BrillDepartment of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
P YoungUniversity Hospital Münster, Department of Neurology, Münster, Germany.
L NobiliDepartment of Neurology, Ospedale Niguarda, Milano, Italy.
M ManconiDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
C L A BassettiDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
SAS-CARE study group
University of Bern · CHOspedale regionale di Lugano · CHUniversità della Svizzera italiana · CHUniversity Hospital of Bern · CHUniversity Hospital Münster · DEUniversity of Genoa · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

OBJECTIVE/

backgroundThe benefit of Continuous Positive Airway Pressure (CPAP) treatment following ischemic stroke in patients with obstructive sleep-disordered breathing (SDB) is unclear. We set out to investigate this open question in a randomized controlled trial as part of the SAS-CARE study. PATIENTS/

methodsNon-sleepy patients (ESS < 10) with ischemic stroke or transient ischemic attack (TIA) and obstructive SDB (AHI ≥ 20) 3 months post-stroke were randomized 1:1 to CPAP treatment (CPAP+) or standard care. Primary outcome was the occurrence of vascular events (TIA/stroke, myocardial infarction/revascularization, hospitalization for heart failure or unstable angina) or death within 24 months post-stroke. Secondary outcomes included Modified Rankin Scale (mRS) and Barthel Index.

resultsAmong 238 SAS-CARE patients 41 (17%) non-sleepy obstructive SDB patients were randomized to CPAP (n = 19) or standard care (n = 22). Most patients (80%) had stroke and were males (78%), mean age was 64 ± 7 years and mean NIHSS score 0.6 ± 1.0 (range: 0-5). The primary endpoint was met by one patient in the standard care arm (a new stroke). In an intent-to treat analysis disregarding adherence, this corresponds to an absolute risk difference of 4.5% or an NNT = 22. mRS and Barthel Index were stable and similar between arms. CPAP adherence was sufficient in 60% of evaluable patients at month 24.

conclusionNo benefit of CPAP started three months post-stroke was found in terms of new cardio- and cerebrovascular events over 2 years. This may be related to the small size of this study, the mild stoke severity, the exclusion of sleepy patients, the delayed start of treatment, and the overall low event rate.

Indexed as

Clinical outcomesCPAPRandomized clinical trialStroke

Identifiers

PMID33870178
PMCPMC8041126
OpenAlexW3092465170

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.