Sleep Disturbances Increase Stroke Risk, Compromise Recovery

New evidence shows a variety of sleep disturbances, namely sleep-disordered breathing (SDB), insomnia, and hypersomnia, increase stroke risk and compromise stroke recovery, according to a new literature review.

Several studies have shown SDB as an independent risk factor for stroke, the researchers said. They recommend sleep studies in transient ischemic attack and stroke patients in view of the very high prevalence (>50%) of SDB. 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. Oxygen, biphasic positive airway pressure, and adaptive servoventilation may be considered in patients with central SDB.
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Recently, both reduced and increased sleep duration, as well as hypersomnia, insomnia, and restless legs syndrome (RLS), also have been suggested to increase stroke risk, the investigators said. Mainly experimental studies found sleep-wake disturbances (SWD) may also 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) come from single case observations and should be used with caution.

“Sleep-related breathing disturbances and sleep-wake disturbances should be carefully monitored in stroke patients on stroke units and rehabilitation wards,” said lead study author Dirk M. Hermann, MD, in the Department of Neurology at University Hospital Essen, in Essen, Germany. “Here, clinical routines should be implemented for sleep assessment and patient treatment. Subjects not yet suffering a stroke should consult a neurologist or sleep specialist when suffering from sleep-wake complaints.”

The authors are involved in large multicenter studies to evaluate a variety of treatment strategies, with the aim of finding the most effective treatments antagonizing vascular risks.

“Sleep-related breathing disturbances and sleep-wake disturbances are highly prevalent in the general population and strongly enriched in stroke patients,” Dr Hermann said. “Diagnosing sleep-related breathing disturbances and sleep-wake disturbances is simple and can efficiently be treated in many cases.”

—Mike Bederka

Reference:

Hermann DM, Bassetti CL. Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery [published online August 3, 2016]. Neurology. doi: http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000003037.