Systematic review of efficacy of continuous positive airway pressure in treatment of epilepsy with obstructive sleep apnea syndrome

Objective To evaluate the efficacy of continuous positive airway pressure (CPAP) ventilation treatment for epilepsy with obstructive sleep apnea syndrome (OSAS). Methods The data were collected from the following words: sleep apnoea, obstructive sleep apnoea, OSA, obstructive sleep apnoea syndrome, OSAS, sleep apnoea syndromes, sleep-related breathing disorder, epilepsy, continuous positive airway pressure, CPAP. PubMed, EMBASE/SCOPUS and Cochrane Library retrieval on randomized controlled clinical trials, clinical guidelines, systematic review (including Meta-analysis), case controlled studies and retrospective cohort studies of CPAP ventilation treatment of epilepsy with OSAS from January 1, 1980 to February 28, 2017. Jadad Scale, Cochrane System Evaluation Handbook and RevMan 5.3 software were used for quality assessment and Meta-analysis. Results A total of 1197 English literatures were obtained, and 17 English articles were included in the study, including one clinical guideline, one systematic review, one Meta-analysis, one randomized controlled clinical trial, 10 case controlled studies and 3 retrospective cohort studies. The results showed that: 1) CPAP ventilation treatment can decrease the seizure frequency or even emarge seizure free in epilepsy with OSAS. 2) CPAP ventilation treatment can reduce the seizure frequency of refractory epilepsy with OSAS. 3) CPAP ventilation treatment can reduce the seizure frequency of elderly epilepsy patients with OSAS. 4) Meta-analysis on three clinical studies (153 epilepsy and OSAS patients) with Jadad ≥ 4 scores showed cases with reduction seizure frequency > 50% in CPAP group were more than those in unused CPAP group ( RR = 3.170, 95%CI: 1.650-6.090; P = 0.001).  Conclusions CPAP ventilation treatment can reduce the seizure frequency of patients with epilepsy and OSAS. The effect of treatment depends on patients compliance. Sudden drug-withdrawl or pressure insuffiency may increase seizure frequency. This conclusion remains to be confirmed. DOI: 10.3969/j.issn.1672-6731.2017.10.005