Sleep Disordered Breathing in Intracerebral Hemorrhage Survivors in Japan: a Meta-analysis and Systematic Review

We evaluated the prevalence and correlates of sleep-disordered breathing (SDB) in intracerebral hemorrhage (ICH) survivors in Japan. A systematic search of PubMed, Scopus, CINAHL, and Clinicaltrials.gov through April 1, 2020 identified studies reporting prevalence and severity of SDB in ICH survivors using American Academy of Sleep Medicine–approved devices. Apnea-hypopnea index (AHI) data were pooled using random-effects models. Subgroup analyses were performed by stroke phase, study design, and testing location. Two Japanese studies were included. The prevalence of SDB was high: AHI > 5 in 91 % (95 % CI 84–95), >15 in 56 % (39–72), and > 30 in 22 % (11–39). Pooled mean AHI was 22.9 (95 % CI 0–58.1). Subgroup analysis showed significantly higher prevalence in prospective studies, inpatient units, and acute stroke compared with retrospective, rehabilitation, and subacute settings (all p < 0.01). Severe SDB was more common in patients with dysarthria, dysphagia, higher BMI, and greater waist circumference; combined dysarthria and dysphagia independently predicted severe SDB (OR 3.4, 95 % CI 1.25–9.25). Obstructive events predominated over central apnea (82.3 % vs 6.1 %, p < 0.001). SDB is highly prevalent among Japanese ICH survivors, particularly in the acute inpatient setting. Oropharyngeal motor impairment may contribute. Larger prospective studies are warranted.