Sleep-related breathing and sleep-wake disturbances in ischemic stroke

Background: Sleep-related breathing disturbances (SDB) and sleep-wake disturbances (SWD) are often neglected in stroke patients. Recent studies suggest that they are frequent and have an impact on stroke outcome. Methods: We review current knowledge about frequency, clinical presentation, and consequences of poststroke SDB and SWD, and discuss treatment options. Results: SDB, presenting with obstructive, central, or mixed apneas, is present in 50%–70% of stroke patients. We recommend screening for SDB in all stroke patients by respirography. Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive SDB, which reverses the vascular risk of the patients. In the absence of controlled trials, CPAP treatment should be reserved for patients with severe obstructive SDB, daytime symptoms (e.g., sleepiness), or high cardiovascular risk profile. Oxygen and adaptive servoventilation may be used for central SDB. SWD including insomnia, disturbances of wakefulness (hypersomnia, excessive daytime sleepiness, fatigue), sleep-related movement disorders (restless legs syndrome, periodic limb movements during sleep), and parasomnias (REM sleep behavior disorder) are found in 10%–50% of patients. SWD are associated with cognitive disturbances and may compromise neurologic recovery. Hypnotics and sedative antidepressants may aggravate SDB and neurologic recovery and should be used with caution. For disturbances of wakefulness, dopaminergic drugs, modafinil, or activating antidepressants may be considered. Poststroke sleep-related movement disorders can be treated with dopaminergic drugs; REM sleep behavior disorder with clonazepam. Conclusions: Sleep-related breathing disturbances and sleep-wake disturbances are frequent conditions that affect stroke outcome. In view of existing treatment options, these conditions deserve the neurologist's awareness.

[1]  R. Scala,et al.  Acceptance, effectiveness and safety of continuous positive airway pressure in acute stroke: a pilot study. , 2009, Respiratory medicine.

[2]  P. Halász,et al.  Pathological Sleep Apnoea Frequency Remains Permanent in Ischaemic Stroke and It Is Transient in Haemorrhagic Stroke , 2002, European Neurology.

[3]  R. Chervin,et al.  Sleep apnea in patients with transient ischemic attack and stroke , 1996, Neurology.

[4]  J. Montserrat,et al.  Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. , 2000, American journal of respiratory and critical care medicine.

[5]  Milena Milanova,et al.  Sleep-Disordered Breathing and Acute Ischemic Stroke: Diagnosis, Risk Factors, Treatment, Evolution, and Long-Term Clinical Outcome , 2006, Stroke.

[6]  P. Achermann,et al.  Evolution of Neurological, Neuropsychological and Sleep-Wake Disturbances After Paramedian Thalamic Stroke , 2008, Stroke.

[7]  A. Thilmann,et al.  Sleep-disordered breathing among patients with first-ever stroke , 2000, Journal of Neurology.

[8]  N. Douglas,et al.  Sleep-disordered breathing after stroke: a randomised controlled trial of continuous positive airway pressure , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[9]  A. Thilmann,et al.  Treatment of obstructive sleep apnoea with nasal continuous positive airway pressure in stroke. , 2001, The European respiratory journal.

[10]  N J Douglas,et al.  Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. , 2001, American journal of respiratory and critical care medicine.

[11]  C. Hommet,et al.  Sleep and brain lesions: a critical review of the literature and additional new cases , 2001, Neurophysiologie Clinique/Clinical Neurophysiology.

[12]  A. Pack,et al.  Molecular signatures of obstructive sleep apnea in adults: a review and perspective. , 2009, Sleep.

[13]  Jose M Marin,et al.  Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study , 2005, The Lancet.

[14]  Y. Gustafson,et al.  Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study. , 2001, The European respiratory journal.

[15]  S. Broadley,et al.  Early investigation and treatment of obstructive sleep apnoea after acute stroke , 2007, Journal of Clinical Neuroscience.

[16]  D. Gottlieb,et al.  Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study , 2008, Neurology.

[17]  Markku Partinen,et al.  Sleep and mortality: a population-based 22-year follow-up study. , 2007, Sleep.

[18]  P. Wanklyn,et al.  Effect of upper airway obstruction in acute stroke on functional outcome at 6 months , 2004, Thorax.

[19]  M. Martínez-García,et al.  Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. , 2005, Chest.

[20]  P. Rothwell,et al.  A Population-Based Study of the Prevalence of Fatigue After Transient Ischemic Attack and Minor Stroke , 2009, Stroke.

[21]  M. Martínez-García,et al.  Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. , 2009, American journal of respiratory and critical care medicine.

[22]  W. Young,et al.  Reemergence of Stroke Deficits With Midazolam Challenge , 2002, Stroke.

[23]  K. Lovblad,et al.  Hypersomnia following paramedian thalamic stroke: A report of 12 patients , 1996, Annals of neurology.

[24]  Claudio L Bassetti,et al.  Central Periodic Breathing During Sleep in Acute Ischemic Stroke , 2007, Stroke.

[25]  J. Broman,et al.  Restless legs symptoms with sleepiness in relation to mortality: 20‐year follow‐up study of a middle‐aged Swedish population , 2008, Psychiatry and clinical neurosciences.

[26]  C. Warlow,et al.  Sleep-Disordered Breathing as a Risk Factor for Cerebrovascular Disease: A Case-Control Study in Patients With Transient Ischemic Attacks , 2003, Stroke.

[27]  J. Harbison,et al.  Sleep-disordered breathing following acute stroke. , 2002, QJM : monthly journal of the Association of Physicians.

[28]  J. Liepert.  Pharmacotherapy in restorative neurology , 2008, Current opinion in neurology.

[29]  E. Ringelstein,et al.  Increased prevalence of sleep apnea in patients with recurring ischemic stroke compared with first stroke victims , 2005, Journal of Neurology.

[30]  F. Turnbull.  Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials , 2003, The Lancet.

[31]  M. Kaste,et al.  Complaints of Poststroke Insomnia and Its Treatment with Mianserin , 2003, Cerebrovascular Diseases.

[32]  C. Guilleminault,et al.  Stroke and treatment with nasal CPAP , 2006, European journal of neurology.

[33]  E. Ringelstein,et al.  Atherosclerosis and Obstructive Sleep Apnea in Patients with Ischemic Stroke , 2007, Cerebrovascular Diseases.

[34]  V. Somers,et al.  Investigating the relationship between stroke and obstructive sleep apnea. , 1996, Stroke.

[35]  T. Erkinjuntti,et al.  Insomnia in Ischemic Stroke Patients , 2002, Cerebrovascular Diseases.

[36]  M. Aldrich,et al.  Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. , 1999, Sleep.

[37]  M. Martínez-García,et al.  Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of dysphagia. , 2006, Chest.

[38]  F. Aizpuru,et al.  Severe Sleep Apnea and Risk of Ischemic Stroke in the Elderly , 2006, Stroke.

[39]  V. Hachinski,et al.  Cerebrovascular events on awakening, patent foramen ovale and obstructive sleep apnea syndrome , 2008, Journal of the Neurological Sciences.

[40]  Shi Yan-fang,et al.  Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients. , 2009, Sleep medicine.

[41]  P. Wanklyn,et al.  Prevalence and Predictors of Upper Airway Obstruction in the First 24 Hours After Acute Stroke , 2002, Stroke.

[42]  Crispin Jenkinson,et al.  Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial , 2002, The Lancet.

[43]  B. A. Phillips.  Long-term Cardiovascular Outcomes in Men With Obstructive Sleep Apnoea-Hypopnoea With or Without Treatment With Continuous Positive Airway Pressure: An Observational Study , 2007 .

[44]  Terry Young,et al.  Association of sleep-disordered breathing and the occurrence of stroke. , 2005, American journal of respiratory and critical care medicine.

[45]  Á. Chamorro,et al.  Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction , 2002, Neurology.

[46]  Duanping Liao,et al.  Insomnia with objective short sleep duration is associated with a high risk for hypertension. , 2009, Sleep.

[47]  J. Montplaisir,et al.  Nocturnal blood pressure changes in patients with restless legs syndrome , 2007, Neurology.

[48]  T. Young,et al.  Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. , 2008, Sleep.

[49]  Kwang-Soo Lee,et al.  Poststroke restless legs syndrome and lesion location: Anatomical considerations , 2009, Movement disorders : official journal of the Movement Disorder Society.

[50]  V. Zivanovic,et al.  Cheyne-Stokes respiration in stroke: relationship to hypocapnia and occult cardiac dysfunction. , 2005, American journal of respiratory and critical care medicine.

[51]  H. Rodgers,et al.  Snoring, daytime sleepiness and stroke: a case–control study of first‐ever stroke , 2003, Journal of sleep research.

[52]  C. Catsman-Berrevoets,et al.  Compulsive pre‐sleep behavior and apathy due to bilateral thalamic stroke , 1988, Neurology.

[53]  J. Concato,et al.  Obstructive sleep apnea as a risk factor for stroke and death. , 2005, The New England journal of medicine.

[54]  D. Hermann,et al.  Central periodic breathing during sleep in 74 patients with acute ischemic stroke – Neurogenic and cardiogenic factors , 2008, Journal of Neurology.

[55]  F. Ferri,et al.  Automatic recognition of abnormal respiratory events during sleep by a pacemaker transthoracic impedance sensor in patients with and without sleep apnea , 2005 .

[56]  J. Woo,et al.  Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance: results in chinese patients with first-ever ischemic stroke. , 2002, Chest.

[57]  A. Wierzbicka,et al.  Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations. , 2007, Journal of physiology and pharmacology : an official journal of the Polish Physiological Society.

[58]  Y. Gustafson,et al.  Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. , 2008, Archives of internal medicine.

[59]  A. Culebras,et al.  Magnetic resonance findings in REM sleep behavior disorder , 1989, Neurology.