Abstract
Background: Sleep-disordered breathing (SDB) and sleep-wake disturbances (SWD) are highly prevalent in stroke patients. Recent studies suggest that they represent both a risk factor and a consequence of stroke and affect stroke recovery, outcome, and recurrence.
Methods: Review of literature.
Results: Several studies have proven SDB to represent an independent risk factor for stroke. Sleep studies in TIA and stroke patients are recommended in view of the very high prevalence (>50%) of SDB (Class IIb, level of evidence B). Treatment of obstructive SDB with continuous positive airway pressure is recommended given the strength of the increasing evidence in support of a positive effect on outcome (Class IIb, level of evidence B). Oxygen, biphasic positive airway pressure, and adaptive servoventilation may be considered in patients with central SDB. Recently, both reduced and increased sleep duration, as well as hypersomnia, insomnia, and restless legs syndrome (RLS), were also suggested to increase stroke risk. Mainly experimental studies found that SWD may in addition impair neuroplasticity processes and functional stroke recovery. Treatment of SWD with hypnotics and sedative antidepressants (insomnia), activating antidepressants or stimulants (hypersomnia), dopaminergic drugs (RLS), and clonazepam (parasomnias) are based on single case observations and should be used with caution.
Conclusions: SDB and SWD increase the risk of stroke in the general population and affect short- and long-term stroke recovery and outcome. Current knowledge supports the systematic implementation of clinical procedures for the diagnosis and treatment of poststroke SDB and SWD on stroke units.
GLOSSARY
- AHI=
- apnea-hypopnea index;
- BMI=
- body mass index;
- CHD=
- coronary heart disease;
- CI=
- confidence interval;
- CPAP=
- continuous positive airway pressure;
- CSA=
- central sleep apnea;
- CSB=
- Cheyne-Stokes breathing;
- EDS=
- excessive daytime sleepiness;
- HR=
- hazard ratio;
- NREM=
- non-REM;
- OR=
- odds ratio;
- OSA=
- obstructive sleep apnea;
- PLMS=
- periodic limb movements during sleep;
- RBD=
- REM sleep behavior disorder;
- RLS=
- restless legs syndrome;
- SDB=
- sleep-disordered breathing;
- SWA=
- slow wave activity;
- SWD=
- sleep-wake disturbances
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Article Processing Charge was paid by the authors.
- Received December 27, 2015.
- Accepted in final form June 9, 2016.
- © 2016 American Academy of Neurology
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.
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