Jennifer Rose V. Molano, MD reviewing Hermann DM and Bassetti CL. Neurology 2016 Aug 3.
Consider evaluating sleep issues in stroke patients.
This Neurology review assesses the types of sleep disturbances seen in stroke, their associations with incident stroke risk and outcomes, and the effects of treatments.
Sleep-Disordered Breathing (SDB)
SDB includes obstructive sleep apnea (OSA) and central sleep apnea, diagnosed by an apnea–hypopnea index (AHI) of ≥5 events per hour. SDB is common after an acute stroke. Those with SDB are at least twice as likely to have incident stroke. OSA with an AHI of ≥15 or ≥20 per hour is associated with an increased risk for death or stroke recurrence. Treatment may improve stroke recovery.
Hypersomnia/Excessive Sleep/Excessive Daytime Sleepiness (EDS)
Hypersomnia or EDS may accompany strokes in the subcortical and pontomesencephalic areas. One study showed increased sleep needs in almost half of patients evaluated 21 ±18 months poststroke. Symptoms may improve after a few months but may also persist. Sleeping ≥8 to 9 hours a day may lead to a 45% increased risk for incident stroke.
Insomnia/Reduced Sleep
Insomnia prevalence may be 50% after a stroke. Pontomesencephalic, paramedian thalamic, and left dorsolateral prefrontal cortex strokes may lead to insomnia. Sleeping ≤6 hours has been associated with a 15% increased risk for incident stroke. Medication treatments give mixed results.
Restless Legs Syndrome (RLS)/Periodic Limb Movements of Sleep (PLMS)
RLS is a nocturnal urge to move the legs that is worse with rest and better with movement. PLMS are leg movements seen on polysomnography and may be seen on the contralateral side of a stroke. Dopamine agonists may improve symptoms, but research is limited on whether they will improve stroke outcomes.
REM Sleep Behavior Disorder (RBD)
RBD is associated with dream enactment behavior clinically, confirmed by REM sleep without atonia on polysomnography. RBD is likely associated with brainstem infarcts. Incident stroke risk and stroke outcomes in RBD are unknown. Treatment for RBD in stroke patients needs further study.
CITATION(S):
Hermann DM and Bassetti CL.Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology 2016 Aug 3; [e-pub].
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