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% (64.4–92.7%) vs. 67.5% (63.2–71.5%), p=0.098], supratentorial vs. infratentorial stroke [64.4% (56.7–71.4%) vs. 56.5% (42.2–60.0%), p=0.171], and cardioembolic [74.3% (59.6–85.0%)] vs. other ischemic stroke subtypes [large artery atherosclerosis: 68.3% (52.5–80.7%), small vessel occlusion: 56.1% (38.2–72.6%), others/undetermined: 47.9% (31.6–64.6%), 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.