Sleep and Stroke

Bassetti, Claudio L

doi:10.1055/s-2005-867073

Cited by 133 publications

(61 citation statements)

References 269 publications

(167 reference statements)

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“…There are 4 other studies investigating sleep in stroke patients without SDB, defined by AHI >10 or >15 [5, 7, 15, 22]. However, since SDB is associated with sleep architecture disturbances, reported for AHI values of >5 [13], and considering the high prevalence of SDB in stroke patients [23], we sought to determine the extent to which that factor accounts for the sleep architecture disturbances. However, since nasal pressure was not assessed, subtler unidentified sleep disturbances may have been present, with a possible impact on sleep.…”

Section: Discussionmentioning

confidence: 99%

Sleep Architecture in Stroke and Relation to Outcome

et al. 2008

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The aim of this study was to investigate sleep architecture in stroke patients, and correlate possible disturbances with the topography, severity and outcome of stroke and the presence of sleep-disordered breathing (SDB). In total, 62 acute stroke patients and 16 age- and gender-matched hospitalised controls underwent polysomnographic studies. Sleep architecture was analysed according to the topography of lesion, severity (National Institutes of Health Stroke Scale) and outcome (Barthel Index) of stroke. We found that sleep architecture is disturbed in stroke patients, regardless of SDB. Stroke patients (without SDB) have reductions in total sleep time and sleep efficiency, reduced stage II and slow wave sleep, increased wakefulness during sleep and increased sleep latency. Rapid eye movement (REM) sleep is reduced when SDB is also present. REM sleep is relatively preserved in cerebellar strokes, as opposed to other topographies. Sleep stages I and REM are negatively associated with stroke severity, and the latency to REM sleep is positively correlated with a good outcome. Sleep architecture is impaired in stroke patients (with fragmentation, increased wakefulness and reduced slow wave sleep), and this correlates with severity and outcome. Sleep disturbances should be investigated and addressed in these patients. Further studies are needed to confirm these findings and assess the clinical and therapeutic implications.

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Section: Discussionmentioning

confidence: 99%

Sleep Architecture in Stroke and Relation to Outcome

et al. 2008

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“…Sleep is thought to facilitate neuroplasticity in normal subjects [19, 20] and may play a role in mediating functional recovery after stroke [21]. Further studies are necessary to clarify the relationship between sleep and stroke recovery, and the potential role of GHB in promoting stoke recovery.…”

Section: Discussionmentioning

confidence: 99%

Gamma-Hydroxybutyrate Accelerates Functional Recovery after Focal Cerebral Ischemia

et al. 2008

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Background and Purpose: γ-Hydroxybutyrate (GHB), a natural metabolite of γ-aminobutyric acid and a drug used in humans to promote slow-wave sleep and treat narcolepsy, has been suggested to protect against ischemic stroke at high doses. This study aimed to assess recovery-promoting effects of GHB at a low dose similar to that used in patients. Methods: Adult mice, subjected to 30 min of intraluminal middle cerebral artery occlusion, were intraperitoneally treated with GHB (100 mg/kg, twice/day, 8 h apart) or saline for 10 days. Motor recovery was evaluated by the grip strength test. The brain lesion was assessed by cresyl violet and NeuN staining 5 weeks after stroke. Expression of neuroplasticity-related genes (GAP43, c-jun, neurocan and ephrin B1) was analyzed by Taqman real-time PCR. Results: GHB-treated mice regained their body weight faster and recovered grip strength (3 weeks after stroke) more quickly than saline-treated mice. This was noteworthy as GHB did not influence ischemia-induced brain injury, as revealed by cresyl violet and neuronal staining. The Taqman PCR assay revealed a decreased expression of c-jun and neurocan in the ischemic striatum of GHB-treated mice in comparison to saline-treated mice. Conclusion: GHB at a low dose accelerates neurological recovery following ischemic stroke. Further studies are necessary to determine the potential relationship between GHB, neuroplasticity, sleep and stroke recovery.

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“…The latter frequently suffer from both psychosocial and organic consequences, such as glucose intolerance [54] , hypertension [55,56] , cardiovascular [57][58][59][60] and cerebrovascular disorders [61][62][63] . According to our own studies on structural and serum surrogate markers of cerebrovascular disease in OSA [64] , even mildly elevated AHI scores predispose to early atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Mandibular Repositioning Appliance on Sleep Structure, Morning Behavior and Clinical Symptomatology in Patients with Snoring and Sleep-Disordered Breathing

et al. 2007

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Background: Mandibular repositioning appliances (MRAs) have become an established treatment for snoring and sleep-disordered breathing – though most studies only focused on the evaluation of respiratory variables. Methods: This single-blind, placebo-controlled case-series study investigated the effects of an individually adjustable MRA on psychopathology, macro-/microstructure of sleep, periodic leg movements, morning performance, mood/affect and psychophysiology. Fifty patients (37 males) aged 59.7 ± 10.3 years, suffering from primary snoring (7), mild (22), moderate (15) and severe apnea (6), spent 4 nights in the sleep laboratory (adaptation, placebo, drug and MRA night). The drug night is not subject of the present paper. Results: Confirmatory statistics showed an improvement of the snoring index by 72%. Descriptively, the apnea index and the apnea-hypopnea index normalized. A clinical improvement was seen in the Pittsburgh Sleep Quality Index, the Zung Anxiety/Depression Scales and the Epworth Sleepiness Scale. The restless legs syndrome also improved. Polysomnographically, sleep stages REM and 4 as well as REM latency increased, stage 3, movement time, stage shifts and periodic leg movements decreased, as did all arousal measures. Subjectively, morning well-being, drive, affectivity and wakefulness improved. Objectively, attention, motor and reaction time performance, critical flicker frequency as well as muscular strength increased, diastolic blood pressure and the pulse rate decreased. Conclusion: Apart from its good therapeutic effects on snoring and respiratory variables (snoring showed complete or partial response in 68%, the apnea-hypopnea index in 67% of the apnea patients), the MRA also improved psychopathology, objective and subjective sleep and awakening quality.

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Sleep and Stroke

Cited by 133 publications

References 269 publications

Sleep Architecture in Stroke and Relation to Outcome

Sleep Architecture in Stroke and Relation to Outcome

Gamma-Hydroxybutyrate Accelerates Functional Recovery after Focal Cerebral Ischemia

Effects of a Mandibular Repositioning Appliance on Sleep Structure, Morning Behavior and Clinical Symptomatology in Patients with Snoring and Sleep-Disordered Breathing

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