Global Prevalence of Sleep-Disordered Breathing in Intracerebral Hemorrhage Survivors: A Meta-Analysis and Systematic Review.

BACKGROUND

Sleep-disordered breathing (SDB) and intracerebral hemorrhage (ICH) share a bidirectional relationship: SDB may increase ICH risk, while ICH can induce or exacerbate SDB. However, the prevalence and characteristics of post-ICH SDB remain poorly defined.

OBJECTIVE

To estimate the prevalence of SDB among ICH survivors and examine associated clinical factors, including the relative burden of obstructive (OSA) versus central sleep apnea (CSA).

METHODS

A systematic review and meta-analysis were performed across PubMed, Scopus, CINAHL, and ClinicalTrials.gov. Studies assessing SDB in adults with ICH using American Academy of Sleep Medicine (AASM) category 1-4 diagnostic devices were included. Random-effects models estimated pooled prevalence at varying apnea-hypopnea index (AHI) thresholds, with subgroup analyses by setting, timing, geography, and diagnostic factors.

RESULTS

Seventeen studies met inclusion criteria. Pooled SDB prevalence was 85% (95% CI: 80-91%) at AHI > 5, with 49% (95% CI: 42-57%) experiencing moderate SDB (AHI > 15), and 21% (95% CI: 15-27%) experiencing severe SDB (AHI > 30). The prevalence of OSA predominated 73% (95% CI: 64% to 82%),while CSA occurred in 5% (95% CI: 2-9%), corresponding to a pooled RR of 7.44 and OR of 53.08 for OSA versus CSA.

CONCLUSIONS

SDB-primarily OSA-is highly prevalent following ICH, underscoring the need for early, routine screening and intervention to improve neurological and cardiovascular outcomes.