Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR.
Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR.
J Stroke Cerebrovasc Dis. 2021 Dec;30(12):106129. doi: 10.1016/j.jstrokecerebrovasdis.2021.106129. Epub 2021 Sep 30.
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.
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.
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.
The prevalence of sleep apnea in the stroke population appears to differ by the subtype, location, etiology and phase of stroke.
最近的荟萃分析指出，约 70%的短暂性脑缺血发作（TIA）/中风患者存在睡眠呼吸暂停。然而，研究之间的异质性很高，而且似乎与中风的阶段无关。我们进行了一项更新的荟萃分析，旨在确定中风患者中睡眠呼吸暂停的患病率是否因中风亚型、病因、严重程度和部位的不同而有所差异，从而可以解释以前研究中观察到的一些未解释的异质性。
我们检索了 Medline、Embase、CINAHL 和 Cochrane Library（从其开始到 2020 年 7 月），以查找使用多导睡眠图报告 TIA/中风患者睡眠呼吸暂停患病率的研究。我们使用随机效应模型计算睡眠呼吸暂停的总患病率，并探讨了患病率是否因中风特征而有所不同。
共有 75 项描述 8670 例中风患者的研究纳入了本荟萃分析。与缺血性中风相比，出血性中风患者的睡眠呼吸暂停总体患病率更高[82.7%（64.4-92.7%）vs. 67.5%（63.2-71.5%），p=0.098]，与幕上中风相比，幕下中风患者的睡眠呼吸暂停患病率更高[64.4%（56.7-71.4%）vs. 56.5%（42.2-60.0%），p=0.171]，心源性栓塞性中风患者的睡眠呼吸暂停患病率更高[74.3%（59.6-85.0%）]，而非其他缺血性中风亚型[大动脉粥样硬化：68.3%（52.5-80.7%），小血管闭塞：56.1%（38.2-72.6%），其他/未确定：47.9%（31.6-64.6%），p=0.089]。报告研究中，睡眠呼吸暂停患病率的异质性部分归因于中风亚型（1.9%）、阶段（5.0%）和部位（14.0%）。
中风人群中睡眠呼吸暂停的患病率似乎因中风亚型、部位、病因和阶段而异。
