Chapter 62 - Sleep and stroke

https://doi.org/10.1016/B978-0-444-52007-4.00021-7Get rights and content

Abstract

Sleep–wake functions and respiration depend upon the integrity of neuronal networks in the brainstem and cerebral hemispheres. Following stroke, sleep–wake disorders (SWDs) and sleep-disordered breathing (SDB) are frequently observed as a direct or indirect (e.g., pain, depression, medications) consequence of acute focal brain damage.

About one-third of stroke patients present with SWD – mostly as insomnia or hypersomnia (excessive daytime sleepiness, fatigue, increased sleep needs). Severe SWDs are often seen after thalamic or brainstem stroke, are linked with neuropsychiatric and psychological deficits, and have a less favorable functional outcome. The relationship between stroke characteristics (topography, severity, outcome), sleep electroencephalographic changes and SWD is complex. In severe/persisting SWD, hypnotics, dopaminergic drugs, and stimulants can be used.

About half of patients have SDB, mostly in the form of obstructive sleep apnea (OSA). OSA represents both a risk factor and a consequence of stroke. The presence of OSA has been linked with poorer outcome. Continuous positive airway pressure is the treatment of choice for OSA. Oxygen and other forms of ventilation may be helpful in central forms of SDB.

Introduction

Understanding sleep disturbances is important in the management of stroke, for several reasons. First, poststroke sleep–wake disorders (SWDs) and sleep-disordered breathing (SDB) are frequent. This is due to the fact that: (a) brain damage per se can impair sleep–wake and breathing control; (b) the consequences of stroke (immobilization, pain, hypoxia, depression, etc.) may also impair these functions; and (c) similar risk factors are associated with stroke and SDB. Second, SWDs and SDB have a negative impact on stroke evolution and outcome. Recurrent hypoxias and hemodynamic instability have a negative impact on stroke evolution, recurrence, and mortality. In addition, sleep fragmentation/disturbances impair daytime wakefulness, cognitive functions, and mood, which in turn unfavorably influence rehabilitation outcome and quality of life. Third, SWDs and SDB – once recognized – can often be treated. This chapter gives an overview of our present understanding of the clinical characteristics, pathophysiology, and management of SWDs and SDB following stroke.

Section snippets

Sleep–Wake Disorders and Stroke

Sleep and wakefulness are functional states of the brain that are controlled by structures in the preoptic area of the hypothalamus thalamus, brainstem, and posterior hypothalamus. In view of the involvement of such a large number of structures throughout the brain in sleep–wake regulation, it is not surprising that stroke (focal ischemia or hemorrhage) may lead to increased sleep needs (hypersomnia), inability to sleep (insomnia), sleep architectural changes, and abnormal sleep behaviors

Frequency and clinical characteristics of sleep-disordered breathing after stroke

Approximately 50–70% of stroke patients have SDB, as defined by an apnea–hypopnea index (AHI) ≥10/hour (Bassetti et al., 1996a, Bassetti et al., 2006, Dyken et al., 1996, Bassetti and Aldrich, 1999b, Parra et al., 2000, Wessendorf et al., 2000a, Hui et al., 2002, Turkington et al., 2002, Selic et al., 2005, Siccoli et al., 2008b). Patients with recurrent stroke have a higher likelihood of SDB than first-ever stroke victims (Dziewas et al., 2005).

In most studies no significant differences were

References (180)

  • R. Greenberg

    Cerebral cortex lesions: the dream process and sleep spindles

    Cortex

    (1966)
  • G. Hajak et al.

    Sleep apnea syndrome and cerebral hemodynamics

    Chest

    (1996)
  • D.S. Hui et al.

    Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance: results in Chinese patients with first-ever ischemic stroke

    Chest

    (2002)
  • M. Kono et al.

    Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome

    Chest

    (2007)
  • M.E. Landau et al.

    The effects of isolated brainstem lesions on human REM sleep

    Sleep Med

    (2005)
  • R. Altin et al.

    Evaluation of carotid artery wall thickness with high-resolution sonography in obstructive sleep apnea syndrome

    J Clin Ultrasound

    (2005)
  • American Academy of Sleep Medicine

    International Classification of Sleep Disorders

  • J. Arpa et al.

    Hypersomnia after tegmental pontine hematoma: case report

    Neurologia

    (1995)
  • M. Arzt et al.

    Association of sleep-disordered breathing and the occurrence of stroke

    Am J Respir Crit Care Med

    (2005)
  • J.J.M. Askenasy et al.

    Sleep apnea as a feature of bulbar stroke

    Stroke

    (1988)
  • A. Autret et al.

    A syndrome of REM and non-REM sleep reduction and lateral gaze paresis after medial tegmental pontine stroke

    Arch Neurol

    (1988)
  • E.M. Bålfors et al.

    Impairment of cerebral perfusion during obstructive sleep apnea syndrome

    Am J Respir Crit Care Med

    (1994)
  • F. Barbé et al.

    Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness

    Ann Intern Med

    (2001)
  • C. Bassetti et al.

    Night time versus daytime transient ischemic attack and ischemic stroke: a prospective study of 110 patients

    J Neurol Neurosurg Psychiatry

    (1999)
  • C. Bassetti et al.

    Sleep apnea in acute cerebrovascular diseases: final report on 128 patients

    Sleep

    (1999)
  • C. Bassetti et al.

    Sleep apnea in the acute phase of TIA and stroke

    Neurology

    (1996)
  • C. Bassetti et al.

    Hypersomnia following thalamic stroke

    Ann Neurol

    (1996)
  • C. Bassetti et al.

    Sleep-disordered breathing in patients with acute supra- and infratentorial stroke

    Stroke

    (1997)
  • C.L. Bassetti

    Sleep and stroke

    Semin Neurol

    (2005)
  • C.L. Bassetti et al.

    Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome

    Stroke

    (2006)
  • H. Bastuji et al.

    Mesodiencephalic infarct with hypersomnia: sleep recordings in two cases (abstract)

    J Sleep Res

    (1994)
  • M. Beelke et al.

    Obstructive sleep apnea can be provocative for right-to-left shunting through a patent foramen ovale

    Sleep

    (2002)
  • M. Bischof et al.

    Total dream loss (Charcot–Wildbrand syndrome): a distinct neuropsychological dysfunction following bilateral posterior cerebral artery stroke

    Ann Neurol

    (2004)
  • J. Bogousslavsky et al.

    Respiratory failure and unilateral caudal brainstem infarction

    Ann Neurol

    (1990)
  • F. Boller et al.

    Paroxysmal “nightmares”: sequel to a stroke responsive to diphenylhydantoin

    Neurology

    (1975)
  • D.L. Brown et al.

    Screening for obstructive sleep apnea in stroke patients: a cost-effectiveness analysis

    Stroke

    (2005)
  • D.L. Brown et al.

    High prevalence of supine sleep in ischemic stroke patients

    Stroke

    (2008)
  • H.W. Brown et al.

    The neurologic basis of Cheyne–Stokes respiration

    Am J Med

    (1961)
  • H. Cairns et al.

    Akinetic mutism with an epidermoid cyst of the 3rd ventricle

    Brain

    (1941)
  • L.R. Caplan et al.

    Poor outcome after lateral medullary infarcts

    Neurology

    (1986)
  • G.D. Cascino et al.

    Brainstem auditory hallucinosis

    Neurology

    (1986)
  • P. Castaigne et al.

    Etude topographique des lésions anatomiques dans les hypersomnies

    Rev Neurol (Paris)

    (1967)
  • P. Castaigne et al.

    Paramedian thalamic and midbrain infarct: Clinical and neuropathological study

    Ann Neurol

    (1981)
  • C.E. Catsman-Berrevoets et al.

    Compulsive pre-sleep behaviour and apathy due to bilateral thalamic stroke

    Neurology

    (1988)
  • M. Charcot

    Un cas de suppression brusque et isolée de la vision mentale des signes et des objects/formes et couleurs)

    Progr Med (Paris)

    (1883)
  • S. Chaturvedi et al.

    Circadian variation in ischemic stroke subtypes

    Stroke

    (1999)
  • K. Chin et al.

    Improvement of factor VII clotting activity following long-term NCPAP treatment in obstructive sleep apnoea syndrome

    Q J Med

    (1998)
  • K. Chin et al.

    Effects of NCPAP on fibrinogen levels in obstructive sleep apnea syndrome

    Am J Respir Crit Care Med

    (1996)
  • H. Claude et al.

    Ramollisement du noyau rouge

    Rev Neurol

    (1912)
  • S.R. Coughlin et al.

    Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome

    Eur Heart J

    (2004)
  • Cited by (0)

    View full text