Meta-Analysis of the Association Between Atrial Fibrillation, Hypertension, Sleep-Disordered Breathing, and Wake-Up Stroke

Background: The occurrence of atrial fibrillation, circadian fluctuation in blood pressure, and oxygen desaturation at night is likely associated with the pathophysiology of wake-up stroke. Whether patients who experience wake-up strokes are candidates for thrombolysis treatment is a serious dilemma. The aim is to investigate the association between risk factors and wake-up stroke and to determine variations that are associated with the pathophysiology of wake-up stroke. Methods: Five major electronic databases were searched using a fitted search strategy to identify relevant studies. Odds ratios with 95% CIs were used to calculate estimates, and the Quality Assessment for Diagnostic Accuracy Studies-2 tool was used to conduct the assessment quality. Results: A total of 29 studies were included in this meta- analysis. Hypertension is not associated with wakeup stroke (odds ratio, 1.14 [95% CI, 0.94-1.37]; P =.18). Atrial fibrillation is an independent risk factor to wakeup stroke, with a statistically significant difference (odds ratio, 1.28 [95% CI, 1.06-1.55]; P =.01). Subgroup analysis showed a different result in patients with sleep-disordered breathing, although no significant difference was assessed. Conclusion: This study revealed that atrial fibrillation is an independent risk factor for wake-up stroke and that patients with atrial fibrillation who also experience sleep- disordered breathing tend to have fewer wakeup strokes.