Prevalence of sleep-disordered breathing after stroke and TIA: A meta-analysis

Andrea Seiler; Millene Camilo; Lyudmila Korostovtseva; Alan G Haynes; Anne-Kathrin Brill; Thomas Horvath; Matthias Egger; Claudio L Bassetti

doi:10.1212/WNL.0000000000006904

Prevalence of sleep-disordered breathing after stroke and TIA: A meta-analysis

Neurology. 2019 Feb 12;92(7):e648-e654. doi: 10.1212/WNL.0000000000006904. Epub 2019 Jan 11.

Authors

Andrea Seiler¹, Millene Camilo¹, Lyudmila Korostovtseva¹, Alan G Haynes¹, Anne-Kathrin Brill¹, Thomas Horvath¹, Matthias Egger¹, Claudio L Bassetti²

Affiliations

¹ From the Sleep Wake Epilepsy Center (A.S., M.C., L.K., A.-K.B., T.H., C.L.B.), and Departments of Neurology (A.S., M.C., L.K., T.H., C.L.B.) and Pulmonary Medicine (A.-K.B.), Bern University Hospital, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Brazil; Hypertension Department (L.K.), Somnology Group, Almazov National Medical Research Center, St. Petersburg, Russia; and CTU Bern (A.G.H.), and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland.
² From the Sleep Wake Epilepsy Center (A.S., M.C., L.K., A.-K.B., T.H., C.L.B.), and Departments of Neurology (A.S., M.C., L.K., T.H., C.L.B.) and Pulmonary Medicine (A.-K.B.), Bern University Hospital, University of Bern, Switzerland; Neurology Division (M.C.), Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Brazil; Hypertension Department (L.K.), Somnology Group, Almazov National Medical Research Center, St. Petersburg, Russia; and CTU Bern (A.G.H.), and Institute of Social and Preventive Medicine (A.G.H., M.E.), University of Bern, Switzerland. claudio.bassetti@insel.ch.

PMID: 30635478
DOI: 10.1212/WNL.0000000000006904

Abstract

Objective: To perform a systematic review and meta-analysis on the prevalence of sleep-disordered breathing (SDB) after stroke.

Methods: We searched PubMed, Embase (Ovid), the Cochrane Library, and CINAHL (from their commencements to April 7, 2017) for clinical studies reporting prevalence and/or severity of SDB after stroke or TIA. Only sleep apnea tests performed with full polysomnography and diagnostic devices of the American Academy of Sleep Medicine categories I-IV were included. We conducted random-effects meta-analysis. PROSPERO registration number: CRD42017072339.

Results: The initial search identified 5,211 publications. Eighty-nine studies (including 7,096 patients) met inclusion criteria. Fifty-four studies were performed in the acute phase after stroke (after less than 1 month), 23 studies in the subacute phase (after 1-3 months), and 12 studies in the chronic phase (after more than 3 months). Mean apnea-hypopnea index was 26.0/h (SD 21.7-31.2). Prevalence of SDB with apnea-hypopnea index greater than 5/h and greater than 30/h was found in 71% (95% confidence interval 66.6%-74.8%) and 30% (95% confidence interval 24.4%-35.5%) of patients, respectively. Severity and prevalence of SDB were similar in all examined phases after stroke, irrespective of the type of sleep apnea test performed. Heterogeneity between studies (I ²) was mostly high.

Conclusion: The high prevalence of SDB after stroke and TIA, which persists over time, is important in light of recent studies reporting the (1) feasibility and (2) efficacy of SDB treatment in this clinical setting.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Humans
Ischemic Attack, Transient / epidemiology*
Polysomnography
Prevalence
Severity of Illness Index
Sleep Apnea Syndromes / diagnosis
Sleep Apnea Syndromes / epidemiology*
Sleep Apnea, Central / diagnosis
Sleep Apnea, Central / epidemiology
Sleep Apnea, Obstructive / diagnosis
Sleep Apnea, Obstructive / epidemiology
Stroke / epidemiology*