Sleep Disorders in Stroke: An Update on Management

Abstract

Stroke is a leading cause of disability and mortality all over the world. Due to an aging population, the incidence of stroke is rising significantly, which has led to devastating consequences for patients. In addition to traditional risk factors such as age, hypertension, hyperlipidemia, diabetes and atrial fibrillation, sleep disorders, as independent modifiable risk factors for stroke, have been highlighted increasingly. In this review, we provide an overview of common types of current sleep disturbances in cerebrovascular diseases, including insomnia, hypersomnia, breathing-related sleep disorders, and parasomnias. Moreover, evidence-based clinical therapeutic strategies and pitfalls of specific sleep disorders after stroke are discussed. We also review the neurobiological mechanisms of these treatments as well as their effects on stroke. Since depression after stroke is so prevalent and closely related to sleep disorders, treatments of post-stroke depression are also briefly mentioned in this review article.

Serum Neurofilament Light Predicts 6-Month Mental Health Outcomes in a Cohort of Patients With Acute Ischemic Stroke

“…Post-stroke mental health disorders, including PSD (17), PSA (18), and PSI (19), are harmful to the quality of life in patients with AIS. Furthermore, these neuropsychological consequences of AIS have adverse effects on functional improvement of AIS.…”

“…Accordingly, the 9item Patient Health Questionnaire (PHQ-9; range, 0-27) (13), the 7-item Generalized Anxiety Disorder (GAD-7) scale (range, 0-21) ( 14), the 7-item Insomnia Severity Index (ISI; range, 0-28) (15), were used to assess the severity of symptoms of depression, anxiety, and insomnia, respectively. The total scores of these measurement tools were interpreted as follows: PHQ-9, normal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) depression; GAD-7, normal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21) anxiety; ISI, normal (0-7), subthreshold (8)(9)(10)(11)(12)(13)(14), moderate (15)(16)(17)(18)(19)(20)(21), and severe (22)…”

Melatonin Involvement in Syncope Associated with Sleep Disturbance: A Case Report

“…To elucidate melatonin involvement in syncope associated with sleep disturbance, reports on the input of melatonin on variables associated with syncope in addition to the observation from the case reported were considered; exogenous melatonin was reported to decrease blood pressure, heart rate and cause hypothermia [10][11][12] which are synonymous features of sleep disturbance induced syncope; [7] hence melatonin is suggested to play a role on sudden drop in blood pressure and heart rate when standing or sitting up immediately after sleep which leads to syncope, since melatonin concentration was reported to be increased in this case.…”

Sleep Disturbances in Neurological Disease: A Target for Intervention

“…Among the estimated 50% of stroke patients presenting with insomnia in the first few months following stroke, insomnia develops after stroke in onethird. 105,106 New onset of post-stroke insomnia is postulated to be in the setting of environmental factors, medications, and comorbidities such as depression and pain, but also may be directly secondary to stroke-related damage to sleep-and circadian-mediating brain regions [105][106][107][108][109][110] . While mechanisms are less clear, decreased sleep duration due to insomnia may predispose patients to stroke via sympathetic and hypothalamic-pituitary-adrenal axis activation, inflammation, and…”