Do sleep disorders influence the risk of stroke?

This article described the link between sleep wake disturbances and stroke incidence, recovery and recurrence. The authors concluded that sleep wake disturbances are a risk factor for stroke and negatively affect recovery.

Stroke patients regularly experience mental and physical impairments. They commonly suffer from sleep wake disturbances (SWD). SWDs are changes in night sleep that result in daytime impairment. They are common in neurologic diseases. It is possible that SWDs are a risk factor for stroke and can affect the recovery of stroke patients.

This article reviewed studies that looked at SWDs as a risk factor for stroke, and their involvement in stroke recovery.

Sleep disordered breathing (SDB) refers to breathing difficulties that occur during sleep. The most common SDB is called obstructive sleep apnea, where there is a decrease in breathing ability during sleep. Evidence has shown that SBD increases the risk of stroke 2-fold.  A meta-analysis with 29 studies including 2343 stroke patients showed that 72% suffered from SDBs. SBD was also associated with a 76% higher risk of recurrent vascular problems and death. Continuous positive airway pressure (CPAP) is recommended to treat OSA. This involves a machine to help people breathe easier at night.

Hypersomnia is excessive sleep of over 8-9 hours’ sleep. A meta-analysis of 11 studies with 559,252 people showed that hypersomnia increases the risk of stroke by at least 45%. There is some evidence to suggest that hypersomnia and fatigue are associated with more frequent nursing home referral and increased risk of death. There are drugs to treat hypersomnia including anti-depressants or stimulants, however it is unknown whether these would affect stroke recovery or recurrence.

Insomnia is reduced sleep of less than 5-6 hours per night. A meta-analysis found that insomnia is a risk factor for stroke and increases risk by at least 15%. Insomnia in stroke patients is linked to depression and poor life satisfaction. The lack of sleep can also affect brain recovery. There are drugs that treat insomnia called hypnotics and anti-depressants, however it is unknown whether they affect stroke recovery or recurrence.

Restless leg syndrome (RLS) causes an urge to move the legs and interferes with sleep. There is not enough evidence to show that RLS increase the risk of stroke. For stroke patients however, it directly results in poorer sleep quality, higher diabetes prevalence and worse stroke recovery than patients without RLS. There are drugs available to treat RLS called dopaminergic drugs however it is unknown whether they affect stroke recovery or recurrence.

The authors concluded that SWDs increase the risk of stroke and affect long-term recovery. They suggest that clinical treatments should be considered.