Sleep and stroke

Antonio Culebras MD (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released October 11, 1993; last updated April 10, 2016; expires April 10, 2019

Overview

In this article, the author highlights the importance of obstructive sleep apnea as a risk factor for stroke. Rehabilitation and recovery are less successful in the presence of sleep apnea. Habitual short and long sleep durations, long-standing night shift work, and periodic leg movements of sleep negatively affect cerebrovascular morbidity and mortality.

Key points

 

• Obstructive sleep apnea is the most common sleep disorder and is a major risk factor for stroke and transient ischemic attack.

 

Central sleep apnea is also a risk factor for ischemic stroke.

 

• All stroke and transient ischemic attack patients should be screened for sleep disorders and, if appropriate, should be considered for treatment with CPAP.

 

• Sleep apnea is present in 70% of acute stroke patients.

 

• Treatment of sleep apnea may lower the incidence of vascular morbidity and mortality.

 

• Wake-up stroke may be related to severe sleep apnea, right-to-left shunt provoked by long-duration apnea events in patients with patent foramen ovale, or atrial fibrillation in sleep apnea patients.

 

Vascular dementia may be delayed in patients compliant with PAP therapy.

Historical note and terminology

The major sleep disorder associated with stroke is sleep apnea (Culebras 2013). Gastaut described obstructive sleep apnea and pointed out its relevance for the pathogenesis of Pickwickian syndrome (Gastaut et al 1966). The Pickwickian syndrome (now termed obesity hypoventilation syndrome) was recognized and named in 1956 (Burwell et al 1956). The association of sleep apnea with stroke was stressed with the discovery of snoring as a risk factor for stroke, the high incidence of sleep apnea in stroke patients (Kapen et al 1991), and a significant peak for stroke incidence in the morning hours (Marshall 1977). In 2008, the American Heart Association highlighted in a scientific statement concepts and evidence important to understanding the interactions between sleep apnea and vascular disease (Somers et al 2008).

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