Prevalence and Determinants of Sleep Apnea in Patients with Stroke: A Meta-Analysis

Abstract

Objectives: Recent meta-analyses have noted that »70% of transient ischemic attack (TIA)/stroke patients have sleep apnea. However, the heterogeneity between studies was high and did not appear to be accounted by the phase of stroke. We conducted an updated meta-analysis and aimed to determine whether the prevalence of sleep apnea amongst stroke patients differs by the subtype, etiology, severity and location of stroke and hence could account for some of the unexplained heterogeneity observed in previous studies. Materials and Methods: We searched Medline, Embase, CINAHL and Cochrane Library (from their commencements to July 2020) for studies which reported the prevalence of sleep apnea by using polysomnography in TIA/stroke patients. We used random-effects model to calculate the pooled prevalence of sleep apnea and explored whether the prevalence differed by stroke characteristics. Results: Seventy-five studies describing 8670 stroke patients were included in this meta-analysis. The overall prevalence of sleep apnea was numerically higher in patients with hemorrhagic vs. ischemic stroke [82.7% (64.4À92.7%) vs. 67.5% (63.2À71.5%), p=0.098], supratentorial vs. infratentorial stroke [64.4% (56.7À71.4%) vs. 56.5% (42.2À60.0%), p=0.171], and cardioembolic [74.3% (59.6À85.0%)] vs. other ischemic stroke subtypes [large artery atherosclerosis: 68.3% (52.5À80.7%), small vessel occlusion: 56.1% (38.2À72.6%), others/ undetermined: 47.9% (31.6À64.6%), p=0.089]. The heterogeneity in sleep apnea prevalence was partially accounted by the subtype (1.9%), phase (5.0%) and location of stroke (14.0%) among reported studies. Conclusions: The prevalence of sleep apnea in the stroke population appears to differ by the subtype, location, etiology and phase of stroke.

Associations of sleep apnea risk and oxygen desaturation indices with cerebral small vessel disease burden in patients with stroke

“…In our main study, we used STOP-BANG to estimate the risk of OSA, with around 60% of participants categorized as intermediate–high OSA-risk. This feature is consistent with recent meta-analyses that have demonstrated a high prevalence of OSA among patients with stroke ( 2 , 34 , 35 ). In our HSAT sub-study, STOP-BANG also showed acceptable diagnostic performance against HSAT.…”

“…Obstructive sleep apnea (OSA) is a common and modifiable risk factor for stroke ( 1 , 2 ). Left undiagnosed and untreated, stroke patients with OSA may be at increased risk of impaired functional and cognitive capacity ( 3 ), and may have a higher risk of recurrent stroke and death ( 4 ).…”

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…In a meta-analysis of 75 studies including 8670 patients with stroke, the prevalence of sleep apnea was nominally higher in those with hemorrhagic (82.7% [95% CI, 64.4%–92.7%]) compared with patients with ischemic (67.5% [95% CI, 63.2%–71.5%],; P =0.098) stroke and in those with supratentorial (64.4% [95% CI, 56.7%–71.4%]) compared with infratentorial (56.5% [95% CI, 42.2%–60.0%]; P =0.171) stroke. 155…”

Sleep Disorders in Patients with Neurologic Disease

“…6 Prior studies showed that neither event type (ischemic stroke, hemorrhagic stroke, or transient ischemic attacks) nor lesion location greatly impacts sleep-disordered breathing rates or severity. 7,8 However, a more recent meta-analysis demonstrated that the prevalence of OSA appeared to be greater in patients with cardioembolic strokes (cardioembolic: 74.3%; large artery atherosclerosis: 68.3%; small vessel occlusion: 56.1%; other or unknown causes: 47.9%), strokes that were supratentorial in location (67.9% versus 56.5%), and in the acute-subacute phase of stroke (acute 68.4% versus subacute 71.3% versus chronic 60.6%). 9 The pathophysiologic mechanisms of OSA as a risk factor for stroke are increasingly understood through the evolving literature.…”

“…Subgroup analysis found that sleep-disordered breathing occurred more frequently in men, those with recurrent rather than initial stroke, and those with unclear stroke etiology (cryptogenic strokes) 6 . Prior studies showed that neither event type (ischemic stroke, hemorrhagic stroke, or transient ischemic attacks) nor lesion location greatly impacts sleep-disordered breathing rates or severity 7,8 . However, a more recent meta-analysis demonstrated that the prevalence of OSA appeared to be greater in patients with cardioembolic strokes (cardioembolic: 74.3%; large artery atherosclerosis: 68.3%; small vessel occlusion: 56.1%; other or unknown causes: 47.9%), strokes that were supratentorial in location (67.9% versus 56.5%), and in the acute-subacute phase of stroke (acute 68.4% versus subacute 71.3% versus chronic 60.6%) 9 …”