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Published in: Sleep and Breathing 3/2018

01-09-2018 | Sleep Breathing Physiology and Disorders • Original Article

A meta-analysis of obstructive sleep apnea in patients with cerebrovascular disease

Authors: Zesheng Wu, Fanghui Chen, Fan Yu, Yi Wang, Zhidong Guo

Published in: Sleep and Breathing | Issue 3/2018

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Abstract

Background

There is increasing evidence that there is a direct relationship between obstructive sleep apnea (OSA) and cerebrovascular (CV) disease. This meta-analysis includes prospective cohorts and cross-sectional studies. It determines the prevalence of OSA among patients with CV disease and also looks for the risk of cerebrovascular events among patients with OSA.

Method

We conducted a computerized literature search in the databases of Medline, Embase, Wanfang, CNKI, Wiley Online Library, and CINAHL (date till April 2017). The random effects model was used to pool the hazard ratio (HR) and effect sizes (ES). Heterogeneity, subgroup, sensitivity analyses, and publication bias were performed.

Result

Fifty-eight studies involving 3 million patients/participants were included. The pooled HR of 15 prospective cohort studies indicated a significant association between OSA and the risk of CV disease after adjustment confounding factors (HR 1.94; 95% CI 1.31–2.89; P = 0.001), and OSA is present in up to 58.8% of patients with CV disease after pooling the remaining 43 studies.

Conclusions

OSA is very common in patients with CV disease. Similarly, patients with OSA are prone to have CV disease.
Literature
2.
go back to reference Writing Group M, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després J-P, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB, American Heart Association Statistics C, Stroke Statistics S (2016) Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 133:447–454CrossRef Writing Group M, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després J-P, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB, American Heart Association Statistics C, Stroke Statistics S (2016) Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 133:447–454CrossRef
4.
go back to reference Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T, American Heart Association Council for High Blood Pressure Research Professional Education Committee CoCC, American Heart Association Stroke C, American Heart Association Council on Cardiovascular N, American College of Cardiology F (2008) Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders research (National Institutes of Health). Circulation 118(10):1080–1111. https://doi.org/10.1161/CIRCULATIONAHA.107.189375 CrossRefPubMed Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T, American Heart Association Council for High Blood Pressure Research Professional Education Committee CoCC, American Heart Association Stroke C, American Heart Association Council on Cardiovascular N, American College of Cardiology F (2008) Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders research (National Institutes of Health). Circulation 118(10):1080–1111. https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​107.​189375 CrossRefPubMed
6.
go back to reference Simpson L, Hillman DR, Cooper MN, Ward KL, Hunter M, Cullen S, James A, Palmer LJ, Mukherjee S, Eastwood P (2013) High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls. Sleep Breathing Schlaf Atmung 17:967–973CrossRefPubMed Simpson L, Hillman DR, Cooper MN, Ward KL, Hunter M, Cullen S, James A, Palmer LJ, Mukherjee S, Eastwood P (2013) High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls. Sleep Breathing Schlaf Atmung 17:967–973CrossRefPubMed
11.
go back to reference Academy Sleep Medicine Task Force A (1999) The report of an American Academy of sleep medicine (AASM) task force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689CrossRef Academy Sleep Medicine Task Force A (1999) The report of an American Academy of sleep medicine (AASM) task force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689CrossRef
15.
go back to reference Johnson KG, Johnson DC (2010) Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med 6(2):131–137 Johnson KG, Johnson DC (2010) Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med 6(2):131–137
30.
go back to reference Martínez-García M-A, Campos-Rodríguez F, Catalán-Serra P, Soler-Cataluña J-J, Almeida-Gonzalez C, De la Cruz Morón I, Durán-Cantolla J, Montserrat J-M (2012) Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am J Respir Crit Care Med 186(9):909–916. https://doi.org/10.1164/rccm.201203-0448OC CrossRefPubMed Martínez-García M-A, Campos-Rodríguez F, Catalán-Serra P, Soler-Cataluña J-J, Almeida-Gonzalez C, De la Cruz Morón I, Durán-Cantolla J, Montserrat J-M (2012) Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am J Respir Crit Care Med 186(9):909–916. https://​doi.​org/​10.​1164/​rccm.​201203-0448OC CrossRefPubMed
32.
35.
go back to reference Stone KL, Blackwell TL, Ancoli-Israel S, Barrett-Connor E, Bauer DC, Cauley JA, Ensrud KE, Hoffman AR, Mehra R, Stefanick ML, Varosy PD, Yaffe K, Redline S, Osteoporotic Fractures in Men Study Research G (2016) Sleep disordered breathing and risk of stroke in older community-dwelling men. Sleep: https://doi.org/10.5665/sleep.5520, 39, 03, 531, 540 Stone KL, Blackwell TL, Ancoli-Israel S, Barrett-Connor E, Bauer DC, Cauley JA, Ensrud KE, Hoffman AR, Mehra R, Stefanick ML, Varosy PD, Yaffe K, Redline S, Osteoporotic Fractures in Men Study Research G (2016) Sleep disordered breathing and risk of stroke in older community-dwelling men. Sleep: https://​doi.​org/​10.​5665/​sleep.​5520, 39, 03, 531, 540
49.
go back to reference Cadilhac DA, Thorpe RD, Pearce DC, Barnes M, Rochford PD, Tarquinio N, Davis SM, Donnan GA, Pierce RJ, Group SIS (2005) Sleep disordered breathing in chronic stroke survivors. A study of the long term follow-up of the SCOPES cohort using home based polysomnography. J Clin Neurosci: Off J Neurosurg Soc Australas 12(6):632–637. https://doi.org/10.1016/j.jocn.2004.08.014 CrossRef Cadilhac DA, Thorpe RD, Pearce DC, Barnes M, Rochford PD, Tarquinio N, Davis SM, Donnan GA, Pierce RJ, Group SIS (2005) Sleep disordered breathing in chronic stroke survivors. A study of the long term follow-up of the SCOPES cohort using home based polysomnography. J Clin Neurosci: Off J Neurosurg Soc Australas 12(6):632–637. https://​doi.​org/​10.​1016/​j.​jocn.​2004.​08.​014 CrossRef
53.
go back to reference Noradina AT, Hamidon BB, Roslan H, Raymond AA (2006) Risk factors for developing sleep-disordered breathing in patients with recent ischaemic stroke. Singap Med J 47:392–399 Noradina AT, Hamidon BB, Roslan H, Raymond AA (2006) Risk factors for developing sleep-disordered breathing in patients with recent ischaemic stroke. Singap Med J 47:392–399
54.
go back to reference Wierzbicka A, Rola R, Wichniak A, Richter P, Ryglewicz D, Jernajczyk W (2006) The incidence of sleep apnea in patients with stroke or transient ischemic attack. J Physiol Pharmacol: Off J Polish Physiol Soc 57(Suppl 4):385–390 Wierzbicka A, Rola R, Wichniak A, Richter P, Ryglewicz D, Jernajczyk W (2006) The incidence of sleep apnea in patients with stroke or transient ischemic attack. J Physiol Pharmacol: Off J Polish Physiol Soc 57(Suppl 4):385–390
58.
60.
go back to reference Rola R, Wierzbicka A, Wichniak A, Jernajczyk W, Richter P, Ryglewicz D (2007) Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations. J Physiol Pharmacol: Off J Polish Physiol Soc 58(Suppl 5):575–582 Rola R, Wierzbicka A, Wichniak A, Jernajczyk W, Richter P, Ryglewicz D (2007) Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations. J Physiol Pharmacol: Off J Polish Physiol Soc 58(Suppl 5):575–582
66.
go back to reference Joo B-E, Seok HY, Yu S-W, Kim B-J, Park K-W, Lee D-H, Jung K-Y (2011) Prevalence of sleep-disordered breathing in acute ischemic stroke as determined using a portable sleep apnea monitoring device in Korean subjects. Sleep Breathing Schlaf Atmung 15:77–82CrossRefPubMed Joo B-E, Seok HY, Yu S-W, Kim B-J, Park K-W, Lee D-H, Jung K-Y (2011) Prevalence of sleep-disordered breathing in acute ischemic stroke as determined using a portable sleep apnea monitoring device in Korean subjects. Sleep Breathing Schlaf Atmung 15:77–82CrossRefPubMed
68.
go back to reference Martínez-García MA, Campos- Rodríguez F, Soler-Cataluña JJ, Catalán-Serra P, Román-Sánchez P, Montserrat JM (2012) Increased incidence of nonfatal cardiovascular events in stroke patients with sleep apnoea: effect of CPAP treatment. The European respiratory journal 39:906–912. Martínez-García MA, Campos- Rodríguez F, Soler-Cataluña JJ, Catalán-Serra P, Román-Sánchez P, Montserrat JM (2012) Increased incidence of nonfatal cardiovascular events in stroke patients with sleep apnoea: effect of CPAP treatment. The European respiratory journal 39:906–912.
69.
73.
go back to reference Cao Y, Tang H-H, He J-C, Yin Z et al (2015) Correlation between obstructive sleep apnea syndrome and ischemic stroke in the elderly. Chin J Geriatr Heat Brain Vessel Dis 17(8):834–836 Cao Y, Tang H-H, He J-C, Yin Z et al (2015) Correlation between obstructive sleep apnea syndrome and ischemic stroke in the elderly. Chin J Geriatr Heat Brain Vessel Dis 17(8):834–836
78.
go back to reference Song T-J, Park J-H, Choi KH, Kim J-H, Choi Y, Chang Y, Kim HJ, Moon J, Kim Y-J, Lee HW (2017) Is obstructive sleep apnea associated with the presence of intracranial cerebral atherosclerosis? Sleep & breathing = Schlaf & Atmung Song T-J, Park J-H, Choi KH, Kim J-H, Choi Y, Chang Y, Kim HJ, Moon J, Kim Y-J, Lee HW (2017) Is obstructive sleep apnea associated with the presence of intracranial cerebral atherosclerosis? Sleep & breathing = Schlaf & Atmung
84.
go back to reference Gafarov VV, Gromova EA, Gagulin IV, Pilipenko PI (2005) A study of the risk factors of stroke development in the framework of WHO program “MONICA-psychosocial”. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova:36–41 Gafarov VV, Gromova EA, Gagulin IV, Pilipenko PI (2005) A study of the risk factors of stroke development in the framework of WHO program “MONICA-psychosocial”. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova:36–41
89.
go back to reference Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep M (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med 5:263–276 Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep M (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med 5:263–276
90.
go back to reference Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, Levy P, Riha R, Bassetti C, Narkiewicz K, Mancia G, WT MN, European Respiratory S, members ECAB (2012) Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens 30:633–646CrossRefPubMed Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, Levy P, Riha R, Bassetti C, Narkiewicz K, Mancia G, WT MN, European Respiratory S, members ECAB (2012) Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens 30:633–646CrossRefPubMed
92.
go back to reference Bazzano LA, Khan Z, Reynolds K, He J (2007) Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension (Dallas, Tex: 1979) 50:417–423CrossRef Bazzano LA, Khan Z, Reynolds K, He J (2007) Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension (Dallas, Tex: 1979) 50:417–423CrossRef
93.
go back to reference Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B (2007) The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 167(8):757–764. https://doi.org/10.1001/archinte.167.8.757 CrossRefPubMed Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B (2007) The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 167(8):757–764. https://​doi.​org/​10.​1001/​archinte.​167.​8.​757 CrossRefPubMed
94.
go back to reference Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, de Atauri JD, Terán J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM, Spanish S, Breathing G (2010) Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 181(7):718–726. https://doi.org/10.1164/rccm.200901-0050OC CrossRefPubMed Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, de Atauri JD, Terán J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM, Spanish S, Breathing G (2010) Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 181(7):718–726. https://​doi.​org/​10.​1164/​rccm.​200901-0050OC CrossRefPubMed
96.
go back to reference Durán-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Terán-Santos J, Aguirregomoscorta JI, Gonzalez M, Lloberes P, Masa JF, De La Peña M, Carrizo S, Mayos M, Barbé F (2010) Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ 341(nov24 1):c5991. https://doi.org/10.1136/bmj.c5991 CrossRefPubMed Durán-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Terán-Santos J, Aguirregomoscorta JI, Gonzalez M, Lloberes P, Masa JF, De La Peña M, Carrizo S, Mayos M, Barbé F (2010) Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ 341(nov24 1):c5991. https://​doi.​org/​10.​1136/​bmj.​c5991 CrossRefPubMed
Metadata
Title
A meta-analysis of obstructive sleep apnea in patients with cerebrovascular disease
Authors
Zesheng Wu
Fanghui Chen
Fan Yu
Yi Wang
Zhidong Guo
Publication date
01-09-2018
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 3/2018
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-017-1604-4

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