Chapter 62 - Sleep and stroke
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
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