The Influence of Obstructive Sleep Apnea on Post-stroke Complications: A Systematic Review and Meta-analysis
Nikhila Gandrakota1, Nithin Kurra2, Manju Ramakrishnan1, Kavya Sudireddy3, Naga Lakshmi Divya Boorle4, Dinesh Jillella5
1Emory University, 2University of Nebraska Medical Center, 3University of Massachusetts Chan Medical School, 4Wayne State University School of Medicine, 5Emory University School of Medicine / Grady Memorial Hospital
Background:
Evidence has shown that obstructive sleep apnea (OSA) is associated with the development of stroke. However, there is limited data on how OSA can influence the development and severity of post stroke complications. This study was done to investigate the potential relationship between OSA and post stroke complications and systematically review the current literature available on the topic.
Design/Methods:
PubMed, Web of Science and Scopus Databases were used to collect data from the published literature up to December 2022. The studies that met the inclusion criteria were selected and Review Manager 5.4.1 was used for statistical analysis of data. Pooling of data with heterogeneity was done using a random-effects model. The findings were presented by using the standard mean differences within their 95% confidence intervals.
Results:
The analysis showed that stroke patients experiencing OSA do not significantly have higher post-stroke complications (i.e mild cognitive impairment, dementia, insomnia, fatigue, sleep quality, post-stroke depression, anxiety, recurrent strokes) compared to those stroke patients who do not have OSA (RR=1.05, 95% CI 0.97 to 1.13). Similarly, stroke patients experiencing OSA did not have any statistically significant risk of depression (RR=0.92, 95% CI = 0.58 to 1.48) or cognitive impairment (RR=1.05, 95% CI −0.90 to 1.23). Among patients with high stroke severity, those who have OSA have higher risk of post-stroke complications than those patients without OSA (RR=1.06, 95% CI −1.01 to 1.12)
Conclusions:
This systematic review and meta-analysis attempted to consolidate the literature and potentially suggested a possible positive relationship between OSA and post-stroke complications mainly with neuropsychiatric comorbidities including cognitive impairment, depression and anxiety. Further studies are required to explore the impact of OSA on post stroke complications.