Stroke patients with obstructive sleep Apnea: Risk of cardiovascular diseases - A systematic review and meta-analysis

There exists a significant pathogenic and epidemiological overlap among stroke, obstructive sleep apnea (OSA), and cardiovascular disease. This systematic review aimed to clarify the association between OSA and cardiovascular disease in stroke patients.

The study protocol was prospectively registered with PROSPERO (registration number: CRD42024517766). A thorough literature search was conducted on February 6, 2024, across multiple databases including PubMed, Embase, Cochrane, and Web of Science. The search utilized a comprehensive set of keywords and their synonyms to identify relevant studies on obstructive sleep apnea (OSA), stroke, and cardiovascular disease (CVD), along with specific terms related to various cardiovascular conditions. Only observational studies reporting cardiovascular events in stroke patients, with and without OSA, were considered for inclusion. Quality assessment of the selected studies was performed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality tool. Data synthesis and analysis were conducted using STATA 18.0, estimating pooled effect sizes via Odds Ratios and 95 % confidence intervals. Heterogeneity was assessed using the I² statistic.

Fifteen studies, involving a total of 559,296 patients, met the eligibility criteria. The findings revealed that stroke patients with obstructive sleep apnea (OSA) exhibited a substantially higher risk of hypertension [2.26 (95 % CI: 1.71-2.97, P < 0.01)], arrhythmia [1.29 (95 % CI: 1.07-1.54, P < 0.01)], Coronary Artery Disease [1.28 (95 % CI: 1.08-1.52, P = 0.005)], heart failure [2.31 (95 % CI: 1.59-3.37, P < 0.01)], and vascular lesions [1.50 (95 % CI: 1.19-1.89, P < 0.01)]. However, the risk for other cardiovascular diseases did not exhibit a statistically significant increase.

These results emphasize the increased susceptibility to cardiovascular diseases in stroke patients with coexisting obstructive sleep apnea (OSA). Timely identification and treatment of OSA in stroke patients could offer potential for reducing the risk of cardiovascular diseases and their related complications.