Sleep disorders and stroke

Abstract

The purpose of this review is to highlight existing literature on the epidemiology, pathophysiology, and treatments of stroke sleep disorders. Stroke sleep disorders are associated with many intermediary vascular risk factors leading to stroke, but they may also influence these risk factors through direct or indirect mechanisms. Sleep disturbances may be further exacerbated by stroke or caused by stroke. Unrecognized and untreated sleep disorders may influence rehabilitation efforts and poor functional outcomes following stroke and increase risk for stroke recurrence. Increasing awareness and improving screening for sleep disorders is paramount in the primary and secondary prevention of stroke and in improving stroke outcomes. Many vital questions about the relationship of sleep disorders and stroke are still unanswered and await future well-designed studies.

Fig. 1

The association between sleep disorders, vascular disease and stroke. Mechanisms specific to sleep disorders are represented in the left column and established vascular mechanisms are represented in the right column. Sleep disorders potentiate vascular mechanisms, and vascular disease, in turn, contributes to sleep disorders (or exacerbate sleep disorders). The sleep-related mechanisms can lead to the development of risk factors (i.e. hypertension) and to sub-clinical vascular disease (brain white matter hyperintesitiens, carotid disease) and stroke; or sleep-related mechanisms are directly linked to stroke.

Fig. 2

Periodic limb movements in sleep. Two-minutes of stage 2 NREM sleep with periodic limb movements (PLMs) in bilateral tibialis anterior (TA) muscles. PLMs with cortical (EEG-defined) arousals (rectangular boxes) show greater autonomic activation (heart rate surges) than those without cortical arousals. Vertical lines represent 30 s sleep epochs. Top to bottom tracings: unilateral right central and occipital EEG leads; left (L) and right (R) tibialis anterior electromyography (TA EMG), heart rate (HR), and electrocardiogram (EKG).