Both sleep-disordered breathing and sleep-wake disturbances impact stroke risk, recovery, and outcome, findings from a study published in Neurology indicate.

Much research has been done to elucidate the effects of sleep disorders on stroke incidence and outcomes. To better understand its impact and develop treatment recommendations, Dirk M. Hermann, MD, of University Hospital in Essen, Germany and Claudio L. Bassetti, MD, of University Hospital in Berne, Switzerland reviewed evidence from 2691 articles from a PubMed search encompassing insomnia, hypersomnia, sleep, restless legs syndrome, and periodic limb movements during sleep and stroke.

The review revealed that sleep-disordered breathing is very prevalent in patients with transient ischemic attack and stroke. When evaluating 2 studies powered for multivariate regression, “OSA, defined by AHI
≥15/h or AHI ≥20/h, predicted death (HR 1.76; 1.05–2.95) or nonfatal cardiovascular events (namely
recurrent stroke) (HR 1.76; 1.12–2.68) in addition to age, sex, vascular risk factors, and Barthel Index,” the authors reported. “Earlier smaller studies reported that SDB negatively affects poststroke arterial blood pressure, early neurologic recovery, and hospitalization duration,” they continued. There is Class IIb, level B evidence that treatment with continuous positive airway pressure (CPAP) may have a positive effect on stroke outcome. In patients with central sleep-disordered breathing, oxygen, biphasic positive airway pressure, and adaptive servoventilation is an option.

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Research on the impact of sleep-wake disorders on stroke risk, recovery, and outcomes is more preliminary; however sleep duration, both increased and decreased, have been shown to increase stroke risk. Several studies have also suggested that sleep-wake disorders may also negatively impact neuroplasticity and stroke recovery.

In treating sleep-wake disorders, the authors cautioned that hypnotics, sedative antidepressants, activating antidepressants, stimulants, dopaminergic drugs, and clonazepam should be used only with close observation, as current evidence is only based on single case observations.

Overall, the evidence suggests that diagnostic and treatment strategies should be included in the management of stroke and transient ischemic attack. Still, some evidence is preliminary and so treatments “should be used thoughtfully considering potential side effects,” the authors concluded.


Hermann DM, Bassetti CL. Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology. 2016;87:1-10.