A Meta-analysis on the Correlation between Snoring and Stroke

doi:10.3969/j.issn.1673-5765.2019.05.008

Abstract

Abstract:

Objective To systematically review the association between snoring and stroke. Methods Electronic databases were searched including PubMed, web of Science, CNKI, Wanfang data, manually searched for original research literature on case-control studies, cohort studies, and cross-sectional studies published from inception to March 1st, 2019. Meta-analysis, subgroup analysis, sensitivity analysis, and publication bias analysis were performed using Stata 15.0 software. Results A total of 10 studies were included, including 235 920 subjects and 2681 stroke patients. No obvious publication bias was founded. Using a fixed-effect model to combine data, the results revealed that the risk of stroke in the snoring population was higher (OR 1.20, 95%CI 1.09-1.31). Hierarchical analysis showed that there was statistical difference between different genders, and there was a higher correlation between snoring and stroke in female population (OR 1.22, 95%CI 1.09-1.34). Conclusions The present evidence suggests that snoring is risk factor of stroke, especially in woman population.

Key words: Snoring; Stroke; Meta-analysis

摘要：

目的系统评价打鼾合并卒中的风险。方法计算机检索PubMed、Web of Science、中国知网、万方等数据库，手工检索打鼾与卒中的病例- 对照研究、队列研究及横断面研究的原始研究文献，检索时限为建库至2018年10月1日。采用Stata 15.0软件进行Meta分析、亚组分析及敏感性分析和发表偏倚分析。结果共纳入文献11篇，包括研究对象235 920例，卒中患者2681例。无明显发表偏倚。研究整体间无明显异质性，采用固定效应模型进行合并，结果显示，打鼾人群发生卒中的风险更高（OR 1.20， 95%CI 1.09～1.31）。分层分析表明，不同性别存在统计学差异，女性人群中打鼾是发生卒中的独立危险因素（OR 1.22, 95%CI 1.09～1.34）。结论打鼾是卒中的风险因素，尤其是在女性人群中。

关键词: 打鼾; 卒中; Meta分析

LIU Shi-Yao, ZHOU Zhou-Yang, JI Shi-Yu,SHI Bing. A Meta-analysis on the Correlation between Snoring and Stroke[J]. Chinese Journal of Stroke, 2019, 14(05): 444-449.

刘师垚，周洲洋，吉诗雨，石冰. 打鼾与卒中相关性Meta分析[J]. 中国卒中杂志, 2019, 14(05): 444-449.

References

[1] DIB S，RAMOS A R，WALLACE D M，et al. Sleep

and stroke[J]. Period Biol，2012，114（3）：369-375.

[2] MENDIS S，DAVIS S，NORRVING B.

Organizational update：the world health organization

global status report on noncommunicable diseases

2014；one more landmark step in the combat

against stroke and vascular disease[J/OL]. Stroke，

2015，46（5）：e121-122. https：//doi.org/10.1161/

STROKEAHA.115.008097.

[3] MESCHIA J F，CHERYL B，BERNADETTE B

A，et al. Guidelines for the primary prevention of

stroke：a statement for healthcare professionals from

the American Heart Association/American Stroke

Association[J]. Stroke，2014，45（12）：3754-832.

[4] KING S，CUELLAR N. Obstructive sleep apnea

as an independent stroke risk factor：a review of

the evidence，stroke prevention guidelines，and

implications for neuroscience nursing practice[J]. J

Neurosci Nurs，2016，48（3）：133-142.

[5] WU Z，CHEN F，YU F，et al. A meta-analysis

of obstructive sleep apnea in patients with

cerebrovascular disease[J]. Sleep Breath，2018，22

（3）：729-742.

[6] XIE C，ZHU R，TIAN Y，et al. Association of

obstructive sleep apnoea with the risk of vascular

outcomes and all-cause mortality：a meta-analysis[J/

OL]. BMJ Open，2017，7（12）：e013983. https：//doi.

org/10.1136/bmjopen-2016-013983.

[7] LI M，LI K，ZHANG X W，et al. Habitual snoring

and risk of stroke：a Meta-analysis of prospective

studies[J/OL]. Int J Cardiol，2015，185：46-49. https：

//doi.org/10.1016/j.ijcard.2015.03.112.

[8] LI D，LIU D，WANG X，et al. Self-reported habitual

snoring and risk of cardiovascular disease and allcause

mortality[J]. Atherosclerosis，2014，235（1）：

189-195.

[9] 简洁君，李国义，田磊，等. 基于人群自我报告的打鼾

习惯与心血管疾病的系统评价及Meta分析[J]. 医学

综述，2016，22（12）：2397-2400.

[10] 王陇德，刘建民，杨弋，等. 我国脑卒中防治仍面临

巨大挑战——《中国脑卒中防治报告2018》概要[J].

中国循环杂志，2019，34（2）：105-119.

[11] BARKER-COLLO S，BENNETT D A，

KRISHNAMURTHI R V，et al. Sex differences

in stroke incidence，prevalence，mortality and

disability-adjusted life years：results from the global

burden of disease study 2013[J]. Neuroepidemiology，

2015，45（3）：203-214.

[12] 文进，李幼平. Meta分析中效应尺度指标的选择[J].

中国循证医学杂志，2007，7（8）：606-613.

[13] ZHANG J，YU K F. What's the relative risk? A

method of correcting the odds ratio in cohort studies

of common outcomes[J]. JAMA，1998，280（19）：

1690-1691.

[14] ELWOOD P，HACK M，PICKERING J，et al.

Sleep disturbance，stroke，and heart disease events：

evidence from the Caerphilly cohort[J]. J Epidemiol

Community Health，2006，60（1）：69-73.

[15] HU F B，WILLETT W C，MANSON J E，et al. Snoring and risk of cardiovascular disease in

women[J]. J Am Coll Cardiol，2000，35（2）：308-

313.

[16] KOSKENVUO M，KAPRIO J，TELAKIVI T，et al.

Snoring as a risk factor for ischaemic heart disease

and stroke in men[J]. Br Med J（Clin Res Ed），1987，

294（6572）：643.

[17] JENNUM P，SCHULTZ-LARSEN K，DAVIDSEN

M，et al. Snoring and risk of stroke and ischaemic

heart disease in a 70 year old population. A 6-year

follow-up study[J]. Int J Epidemiol，1994，23（6）：

1159-1164.

[18] MARSHALL N S，WONG K K，CULLEN S R，et

al. Snoring is not associated with all-cause mortality，

incident cardiovascular disease，or stroke in the

Busselton Health Study[J]. Sleep，2012，35（9）：

1235-1240.

[19] YEBOAH J，REDLINE S，JOHNSON C，et al.

Association between sleep apnea，snoring，incident

cardiovascular events and all-cause mortality in an

adult population：MESA[J]. Atherosclerosis，2011，

219（2）：963-968.

[20] SANDS M，LOUCKS E B，LU B，et al. Selfreported

snoring and risk of cardiovascular disease

among postmenopausal women（from the Women's

Health Initiative）[J]. Am J Cardiol，2013，111（4）：

540-546.

[21] 武海滨，王浩，胡如英，等. 成年人睡眠时间与脑卒

中患病关系的研究[J]. 中华流行病学杂志，2015，36

（11）：1210-1215.

[22] DAVIES D P，RODGERS H，WALSHAW D，et

al. Snoring，daytime sleepiness and stroke：a casecontrol

study of first-ever stroke[J]. J Sleep Res，

2003，12（4）：313-318.

[23] 徐卫革，马耀梅. 女性脑卒中危险因素的研究[J]. 中

华疾病控制杂志，2001，5（4）：346-347.

[24] WEN Y，PI F H，GUO P，et al. Sleep duration，

daytime napping，markers of obstructive sleep apnea

and stroke in a population of southern China[J/OL].

Sci Rep，2016，6：34 689. https：//doi.org/10.1038/

srep34689.

[25] American Academy of Sleep Medicine. Women

underreport prevalence and intensity of their own

snoring[EB/OL]. （2019-04-23）[2019-05-02]. https：

//aasm.org/women-underreport-snoring/.

[26] 张珺辉，黄席珍. 睡眠呼吸暂停/低通气综合征的

危害性及健康指导[J]. 中国全科医学，2002，5（3）：

185-187.

[27] 李建标，何锦照，江震钦. 不良生活方式、负性情绪

与脑卒中的相关性研究[J]. 临床医学工程，2017，24

（11）：1531-1533.

[28] KOCH S，ZUNIGA S，RABINSTEIN A A，et al.

Signs and symptoms of sleep apnea and acute stroke

severity：is sleep apnea neuroprotective?[J]. J Stroke

Cerebrovasc Dis，2007，16（3）：114-118.

[29] MEYER M M D，JACQUET W，VANDERVEKEN

O M，et al. Systematic review of the different aspects

of primary snoring[J/OL]. Sleep Med Rev，2019，45：

88-94. https：//doi.org/10.1016/j.smrv.2019.03.001.