Frequency of Sleep Apnea in Stroke and TIA Patients: A Meta-analysis

Study Objectives: To determine the frequency of sleep disordered breathing (SDB) in ischemic and hemorrhagic stroke and transient ischemic attack (TIA) patients by meta-analysis.Methods: A systematic literature search using Medline, EM-BASE and CINAHL and a manual review of references through December 2008 was conducted using specific search terms.The frequency of SDB stratified by apnea hypopnea index (AHI) was extracted by the author.Weighted averages using a random-effects model are reported with 95% confidence intervals.Results: Twenty-nine articles evaluating patients with auto-CPAP, limited-channel sleep study, or full polysomnography were included in this study.In meta-analysis of 2,343 ischemic or hemorrhagic stroke and TIA patients, the frequency of SDB with AHI > 5 was 72% and with AHI > 20 was 38%.Only 7% of the SDB was primarily central apnea.There was no significant difference in SDB prevalence by event type, timing after stroke, or type of monitoring.Males had a higher percentage of SDB (AHI > 10) than females (65% compared to 48% p = 0.001).Patients with recurrent strokes had a higher percentage of SDB (AHI > 10) than initial strokes (74% compared to 57% p = 0.013).Patients with unknown etiology of stroke had a higher and cardioembolic etiology a lower percentage of SDB than other etiologies.Conclusions: SDB is very common in stroke patients irrespective of type of stroke or timing after stroke and is typically obstructive in nature.Since clinical history alone does not identify many patients with SDB, sleep studies should be considered in all stroke and TIA patients.