Background
Methods
Search strategy
Study selection and screening
Data extraction
Results
Characteristics of the included studies
Author/year | Country | Data sources | Sample size | Age (years) | Eligibility criteria | Study period | Settings | Stroke stage |
---|---|---|---|---|---|---|---|---|
Sico/2017 [23] | America | Randomized trials | 303 | Development: 70.8 ± 9.9 Validation: 60.7 ± 9.9 | Patient with ischemic stroke; history with hypertension | 2004–2008 | Hospital | Acute or subacute |
Brown/2020 [25] | America | Cross-sectional study | 1330 | 65.0 ±12.6 | Patients with stroke; ≥ 45 years old | 2010–2018 | Acute care hospital | Acute |
Boulos/2019 [29] | Canada | Cross-sectional study | 231 | 64.4 ± 15.3 | Outpatients with ischemic Stroke; English speaking; | 4/2011–7/2017 | Stroke prevention clinic | No restriction |
Katzan/2016 [27] | America | Retrospective cohort | 208 | 55.4 ± 14.1 | Patients with stroke | 1/2011–12/2012 | Cerebrovascular clinic | No restriction |
Bernardini/2021 [21] | Italy | Cross-sectional study | 30 | Not mentioned | Patient with cerebrovascular event | 8/2019–7/2020 | Stroke unit | Acute |
Zhang/2019 [22] | China | Cross-sectional study | 124 | 62.6 ± 12.6 | Patients with stroke | 6/2016–5/2017 | Neurology unit | Acute |
Boulos/2016 [24] | Canada | Cross-sectional study | 69 | 68.3 ± 14.2 | Patients with stroke (ischemic or hemorrhagic) | 7/2014–6/2015 | Stroke unit or stroke prevention clinic | Acute and subacute |
Petrie/2021 [26] | America | Retrospective cohort | 344 | 59.0 ± 11.8 | Patients with acute stroke, subarachnoid hemorrhage | 10/2014–10/2015 | Stroke unit | Acute |
Šiarnik/2020 [31] | Slovakia | Cross-sectional study | 120 | Development: 67.2 ± 9.1 Validation: 62.4 ± 13.3 | Patients with acute ischemic stroke | Not mentioned | Stroke unit | Acute |
Camilo/2014 [28] | Brazil | Cross-sectional study | 39 | 63.2 ± 12.2 | Patients with first ischemic stroke > 18 years old | Not mentioned | Emergency unit | Acute |
Srijithesh/2011 [30] | India | Cross-sectional study | 39 | 56.5 | Patients with hemorrhagic or ischemic stroke | Not mentioned | Neurology unit | Subacute |
Outcome variables and prediction factors
Author/year | Outcome variables | Candidate predictors | Predictors in the final model | ||||
---|---|---|---|---|---|---|---|
Time of assessment | Measurement method/definition | N | Variables | Time of assessment | N | Variables | |
Sico/2017 [23] | Within 30 days | PSG, AHI ≥ 5/h | 19 | Age, race, gender, height, weight, BMI, large neck circumference, waist circumference, medical history, smoking, cocaine use or used, Charlson comorbidity score, modified Rankin, PHQ-8, NIHSS score, ESS, BQ, SACS, STOP-BANG | No stated | 7 | Female, weight, large neck, congestive heart failure, diabetes, ESS, NIHSS |
Brown/2020 [25] | Within 14 days from stroke | HSAT, REI ≥ 10/h | 19 | Age, race, hypertension, sex, diabetes, atrial fibrillation, smoking, history of TIA/stroke, excessive alcohol consumption, congestive heart failure, coronary artery disease, hyper cholesterol, BMI, NIHSS, neck circumference, waist circumference, BQ, Friedman palate position | After stroke onset | 6 | Neck circumference, BMI, waist circumference, age, NIHSS, daytime sleepiness |
Boulos/2019 [29] | STOP-BAG (snoring, tired, observed, high blood pressure, BMI, age, neck circumference, gender) | After stroke diagnosis | 8 | STOP-BAG-O (snoring, tired observed, high blood pressure, BMI, age, neck circumference, gender, oximetry) | |||
Katzan/2016 [27] | STOP (snoring, tired, observed, high blood pressure), BMI, age, race, neck circumference, married status, sex, history of coronary artery disease, sleep time, smoking | No stated | 7 | STOP-BAG2- (STOP, sex, BMI, age) | |||
Bernardini/2021 [21] | No stated | PSG, AHI ≥ 5/h | No stated | No stated | No stated | ECG, peripheral oxygen saturation (SpO2) | |
Zhang/2019 [22] | No mentioned | PSG, AHI ≥ 10/h | 11 | Age, gender, BMI, neck circumference, smoking, alcohol consumption, medical history (hypertension, diabetes, AF, CHD, stroke, wake up stroke, progressive stroke, TIA, Ischemic stroke), NIHSS, homocysteine, CRP, hemoglobin A1c | With 1 week from stroke | 4 | Modified 4 V (sex, neck, blood pressure, snoring) |
Boulos/2016 [24] | 180 days after stroke | HSAT, AHI ≥ 10/h | 10 | 4 V (sex, BMI, blood pressure, and snoring), STOP-BAG (snoring, tired, observed, high blood pressure, BMI, age, gender), Berlin Questionnaire, and ESS, stroke location, atrial fibrillation, diabetes, smoking, hyperlipidemia, NIHSS | Within 72 h of sleep testing | 4 | 4 V (sex, BMI, blood pressure, snoring) |
Petrie/2021 [26] | 64 days after stroke | PSG, AHI ≥ 5/h | No fit | Not fit | After admission | / | / |
Šiarnik/2020 [31] | Within 7 days after the stroke onset | PSG, AHI ≥ 15/h | 12 | Age, gender, BMI, neck, past medical history (arterial hypertension, diabetes mellitus, ischemic heart disease, atrial fibrillation, heart failure, chronic kidney disease), NIHSS, ESS | Within 7 days from stroke onset | 3 | SLAPS (BMI, wake-up stroke onset, diastolic dysfunction in echocardiography) |
Camilo/2014 [28] | Within 24 h after stroke | PSG, AHI ≥ 10/h | 13 | Age, male, hypertension, diabetes, dyslipidemia, smoking, alcohol consumption, BMI, neck, BQ, CT, ESS, NIHSS | No stated | 2 | SOS score (BQ and ESS) |
Srijithesh/2011 [30] | 28 days after stroke onset | PSG, AHI ≥ 5/h | No stated | BQ | No stated | / | BQ and combination of ESS and BQ |
Model development and performance
Author/year | Missing data | Model development | Model performance | |||||
---|---|---|---|---|---|---|---|---|
Model type | Predictor selection method | Model format | Validation methods | Calibration | Discrimination | Classification | ||
Sico/2017 [23] | No imputation | Logistic regression | Backward with uniform P-value | / | External validation | / | D-C: 0.732 V-C: 0.731 | D-SN: 91.4%; SP: 43.8%; NPV: 76.2%, PPV: 72.1%; V-SN: 100%; SP: 12.5%; NPV: 100%; PPV: 79.6% |
Brown/2020 [25] | Separate category by default | Machine learning | Stepwise selection | / | / | / | C: 0.75 | / |
Boulos/2019 [29] | / | Logistic regression | / | / | Bootstrapping | / | C: 0.751 | SN: 95.9%; SP: 26.1%; PPV: 48.4%; NPV: 89.7% |
Katzan/2016 [27] | Multiple imputation | Logistic regression | Bootstrapping | Formula | Bootstrapping | / | STOP-BAG2 + C: 0.84 | SN: 94%; SP: 60% |
Bernardini/2021 [21] | / | Convolutional deep learning | / | / | / | / | / | / |
Zhang/2019 [22] | / | / | / | / | / | / | AUC: 0.835 | SN: 74.1%; SP: 76.9%; PPV: 87.5%; NPV: 57.7% |
Boulos/2016 [24] | / | Logistic regression | / | / | / | / | AUC: STOP-BAG: 0.677; 4 V: 0.688; BQ: 0.563; SOS: 0.506 | 4 V: SN: 59.4%; SP: 59.5%: PPV: 55.9%; NPV: 62.9% |
Petrie/2021 [26] | / | / | / | / | / | / | C-statistic SB, 0.572; ESS, 0.502; BQ, 0.640 | BQ: SN: 36%; SP: 62% ESS: SN: 68%; SP: 62% SB: SN: 81%; SP: 33% |
Šiarnik/2020 [31] | / | Logistic regression | Stepwise selection | / | / | / | AUC: 0.81 | SN: 82.9%; SP: 71.9%, |
Camilo/2014 [28] | / | Logistic regression | / | / | / | / | AUC: 0.813 | SN: 90%; NPV: 94.5%; SP: 55.6%, PPV: 27.1% |
Srijithesh/2011 [30] | / | / | / | / | / | BQ: SN: 68.2%, SP: 58.8%, PPV: 68.2%, NPV: 58.8% Combined BQ & ESS: SN: 50%, SP: 88.2%, PPV: 84.6%, NPV: 57.7% |
Quality assessment
Author/year | Risk of bias | Application | Overall assessment | ||||||
---|---|---|---|---|---|---|---|---|---|
Participants | Predictors | Outcomes | Analysis | Participants | Predictors | Outcomes | ROB | Applicability | |
Sico/2017 [23] | + | - | + | − | − | − | + | − | − |
Brown/2020 [25] | + | + | + | − | + | + | + | − | − |
Boulos/2019 [29] | + | - | + | − | − | + | + | − | − |
Katzan/2016 [27] | + | + | + | − | + | − | + | − | − |
Bernardini/2021 [21] | + | + | + | − | + | − | + | − | − |
Zhang/2019 [22] | + | - | + | − | + | + | + | − | + |
Boulos/2016 [24] | + | + | + | − | − | + | + | − | − |
Petrie/2021 [26] | + | + | + | − | − | + | + | − | − |
Šiarnik/2020 [31] | + | + | + | − | + | + | + | − | + |
Camilo/2014 [28] | + | + | + | − | + | − | + | − | − |
Srijithesh/2011 [30] | + | + | + | − | + | + | + | − | + |
Items | Author/year | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Sico/2017 | Brown/2020 | Boulos/2019 | Katzan/2016 | Bernardini/2021 | Zhang/2019 | Boulos/2016 | Petrie/2021 | Šiarnik/2020 | Camilo/2014 | Srijithesh/2011 | ||
Participants | Were appropriate data sources used, e.g., cohort, randomized controlled trial, or nested case–control study data? | + | + | + | + | + | + | + | + | + | + | + |
Were all inclusions and exclusions of participants appropriate? | + | + | + | + | + | + | + | + | + | + | + | |
Predictors | Were predictors defined and assessed in a similar way for all participants? | + | + | ? | + | + | ? | + | + | + | + | + |
Were predictor assessments made without knowledge of outcome data? | ? | + | ? | + | + | ? | + | + | + | + | + | |
Are all predictors available at the time the model is intended to be used? | + | + | + | + | + | + | + | + | + | + | + | |
Outcome | Was the outcome determined appropriately? | + | + | + | + | + | + | + | + | + | + | + |
Was a prespecified or standard outcome definition used? | + | + | + | + | + | + | + | + | + | + | + | |
Were predictors excluded from the outcome definition? | + | + | + | + | + | + | + | + | + | + | + | |
Was the outcome defined and determined in a similar way for all participants? | + | + | + | + | + | + | + | + | + | + | + | |
Was the outcome determined without knowledge of predictor information? | + | + | + | + | + | + | + | + | + | + | + | |
Was the time interval between predictor assessment and outcome determination appropriate? | + | + | + | + | + | + | + | + | + | + | + | |
Analysis | Were there a reasonable number of participants with the outcome? | - | - | + | + | - | - | - | + | + | - | - |
Were continuous and categorical predictors handled appropriately? | + | + | + | + | + | + | + | + | + | + | + | |
Were all enrolled participants included in the analysis? | + | + | + | + | + | + | + | + | + | + | + | |
Were participants with missing data handled appropriately? | + | ? | ? | + | ? | + | ? | ? | ? | ? | ? | |
Was selection of predictors based on univariable analysis avoided? (Model development studies only) | + | + | + | + | + | + | + | + | + | + | + | |
Were complexities in the data (e.g., censoring, competing risks, sampling of control participants) accounted for appropriately? | + | + | + | + | + | + | + | + | + | + | + | |
Were relevant model performance measures evaluated appropriately? | - | - | - | - | - | - | - | - | - | - | - | |
Were model overfitting and optimism in model performance accounted for? (Model development studies only) | - | - | - | ? | - | - | - | - | - | - | - | |
Do predictors and their assigned weights in the final model correspond to the results from the reported multivariable analysis? (Model development studies only)? | - | - | - | + | - | - | - | - | - | - | - |