1 Orthopedic Surgery, Azra Naheed Medical College, Superior University, Lahore, Pakistan.
2 Department of Internal Medicine, Montefiore St. Luke’s Cornwall Hospital, NY, USA.
3 Community Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
4 Department of Internal Medicine, Islam Central Hospital-Islam Medical and Dental College, Sialkot, Pakistan.
5 Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
6 General Medicine, Shaikh Zayed Hospital, Lahore, Pakistan.
7 Jinnah Hospital, Allama Iqbal Medical College, Lahore, Pakistan.
8 Department of Internal Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, India.
9 Department of Internal Medicine, Nanchang University, Nanchang, China.
World Journal of Advanced Research and Reviews, 2025, 26(01), 2317-2326
Article DOI: 10.30574/wjarr.2025.26.1.1043
Received on 26 February 2025; revised on 03 April 2025; accepted on 05 April 2025
Background: Sleep disorders, including insomnia and obstructive sleep apnea (OSA), have been increasingly associated with cardiovascular disease, yet their relationship with stroke risk remains debated. Some studies report a strong link, while others find limited or no association. This study aims to clarify this connection and provide more precise insight into this public health issue.
Methods: A systematic review and meta-analysis were carried out in accordance with PRISMA guidelines. Searches of PubMed, NIH, Scopus, and Google Scholar identified 1,040 articles, of which 10 studies, comprising 514 participants, met the inclusion criteria. Studies included cohort, case-control, and cross-sectional designs with adequate statistical power to report risk estimates for stroke associated with sleep disorders. Two independent investigators conducted data extraction and assessed study quality using the Newcastle-Ottawa Scale. Pooled relative risks (RR) were calculated using the DerSimonian-Laird random-effects model. Heterogeneity was evaluated using the I² statistic, and publication bias was assessed with funnel plots and Egger’s test.
Results: Sleep disorders were significantly associated with a higher risk of stroke, with a pooled RR of 1.82 (95% CI 1.45-2.30, p < 0.001). Among subgroups, OSA posed the strongest association (RR 1.82, 95% CI 1.64-2.89), followed by insomnia (RR 1.32, 95% CI 1.12-1.92). Substantial heterogeneity was observed across studies (I² = 76%), mainly due to variations in study design, diagnostic criteria, and participant characteristics. Sensitivity analyses supported the stability of the results, and no significant publication bias was detected.
Conclusions: This meta-analysis provides strong evidence that sleep disorders, particularly OSA and insomnia, are associated with an increased risk of stroke. Given the high prevalence of sleep disturbances, routine screening for sleep disorders may play a valuable role in enhancing stroke prevention strategies. Future studies should evaluate the effectiveness of targeted interventions aimed at reducing stroke risk among affected individuals.
Apnea; Cardiovascular Disease; Insomnia; OSA; Sleep Disorders; Stroke Risk
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Usama Abbas, Mohammad Ala\' Alajjuri, Tooba Adil, Hamza Sakhi Chatha, Daniel O. Obi, Muhammad Adnan Akhtar, Muhammad Subhan, enkata Dileep Kumar Veldi and Siffat Ullah. The association between sleep disorder and stroke risk: A meta-analysis of observational studies. World Journal of Advanced Research and Reviews, 2025, 26(1), 2317-2326. Article DOI: https://doi.org/10.30574/wjarr.2025.26.1.1043