Sleep and Stroke.

Stroke is the leading cause of serious long-term disability in the United States, leaving less than half of survivors able to return directly home. Stroke recurrence, estimated as high as 17% over 5 years, also remains unacceptably high. The use of lytic drugs and endovascular devices has revolutionized the care of select stroke patients in the acute setting. However, enormous challenges remain in changing the trajectory of stroke recovery for the vast majority of patients who do not qualify or remain disabled after these treatments, and also in preventing the accumulating disability associated with stroke recurrence. The role of sleep disorders in stroke outcome and recurrence has become a pressing question. Despite estimates of greater than 50% prevalence of sleep disorders after stroke, only about 6% of stroke survivors are offered formal sleep testing and an estimated 2% complete such testing in the 3-month poststroke period. The reasons for the low rate of screening are at least partly related to the lack of awareness about sleep disorders among stroke providers (Figure). This review evaluates the role of sleep disorders, including sleepdisordered breathing (SDB) and sleep-wake cycle disorders, in stroke risk and examines the impact of their treatment on stroke outcome.