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Post-stroke sleep disturbance and recurrent cardiovascular and cerebrovascular events: A systematic review and meta-analysis

期刊

SLEEP MEDICINE
卷 104, 期 -, 页码 29-41

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ELSEVIER
DOI: 10.1016/j.sleep.2023.02.019

关键词

Sleep; Sleep disorder; Stroke; Transient ischemic attack; Major acute cardiovascular event; Recurrent event; Systematic review

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Despite improvements in survival rates, the risk of recurrent events after stroke remains high. Sleep disturbances are both a contributor to and a consequence of stroke, making the relationship complex. This study aimed to examine the association between sleep disturbance and recurrent major acute coronary events or all-cause mortality in stroke survivors. The analysis of 32 studies found a positive relationship between obstructive sleep apnea (OSA) and recurrent events/mortality, while the findings on positive airway pressure (PAP) treatment for OSA were mixed.
Despite improvements in survival rates, risk of recurrent events following stroke remains high. Identifying intervention targets to reduce secondary cardiovascular risk in stroke survivors is a priority. The relationship between sleep and stroke is complex: sleep disturbances are likely both a contributor to, and consequence of, stroke. The current aim was to examine the association between sleep disturbance and recurrent major acute coronary events or all-cause mortality in the post-stroke population. Thirty-two studies were identified, including 22 observational studies and 10 randomized clinical trials (RCTs). Identified studies included the following as predictors of post-stroke recurrent events: obstructive sleep apnea (OSA, n = 15 studies), treatment of OSA with positive airway pressure (PAP, n = 13 studies), sleep quality and/or insomnia (n = 3 studies), sleep duration (n = 1 study), polysomnographic sleep/sleep architecture metrics (n = 1 study), and restless legs syndrome (n = 1 study). A positive relationship of OSA and/or OSA severity with recurrent events/mortality was seen. Findings on PAP treatment for OSA were mixed. Positive findings indicating a benefit of PAP for post-stroke risk came largely from observational studies (pooled RR [95% CI] for association between PAP and recurrent cardiovascular event: 0.37 [0.17-0.79], I2 = 0%). Negative findings came largely from RCTs (RR [95% CI] for association between PAP and recurrent cardiovascular event + death: 0.70 [0.43-1.13], I2 = 30%). From the limited number of studies conducted to date, insomnia symptoms/poor sleep quality and long sleep duration were associated with increased risk. Sleep, a modifiable behavior, may be a secondary prevention target to reduce the risk of recurrent event and death following stroke. Systematic review registration: PROSPERO CRD42021266558.

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