29 Oct World stroke day
The relationship between stroke and sleep disorder has been studied by many researchers. Evidence suggests that sleep disorder is a consequence[i] and a high-risk factor of stroke[ii]. Untreated sleep disorder even hinders rehabilitation after stroke and increases the risk of stroke recurrence[iii].
Obstructive sleep apnea (OSA) is one of the most common sleep disorders that is diagnosed after a stroke. It is sleep-disordered breathing that is characterized by repetitive closure of the upper airway during sleep. OSA strongly associates with multiple vascular diseases, including hypertension, and atrial fibrillation[iv]. It is well known that various vascular diseases are a leading cause of stroke. Therefore, OSA and many other sleep disorders are strongly associated with stroke. 72% of stroke patients are diagnosed with sleep-disordered breathing[v].
Sleep has an essential impact on motor learning, which is a central rehabilitation mechanism after stroke[vi]. Research has demonstrated that stroke patients performed better on newly learned motor tasks after a night’s sleep[vii]. It also shows that sleep disorder has a negative impact on all stages of recovery from stroke, including longer lengths of stay in the hospital[viii].
References[i] Laver, Kate E et al. “Sleep Disturbance and Disorders within Adult Inpatient Rehabilitation Settings: A Systematic Review to Identify Both the Prevalence of Disorders and the Efficacy of Existing Interventions.” Journal of the American Medical Directors Association vol. 21,12 (2020): 1824-1832 [ii] Yaggi, H. Klar et al. “Obstructive Sleep Apnea as a Risk Factor for Stroke and Death.” The New England journal of medicine 353.19 (2005): 2034–2041. [iii] Birkbak J, Clark AJ, Rod NH. The effect of sleep disordered breathing on the outcome of stroke and transient ischemic attack: a systematic review. J Clin Sleep Med. 2014;10: 103-108. [iv] Sanchez-De-la-Torre, Manuel, Francisco Campos-Rodriguez, and Ferran Barbe. “Obstructive Sleep Apnoea and Cardiovascular Disease.” The lancet respiratory medicine 1.1 (2013): 61–72 [v] Johnson, Karin G, and Douglas C Johnson. “Frequency of Sleep Apnea in Stroke and TIA Patients: a Meta-Analysis.” Journal of clinical sleep medicine 6.2 (2010): 131–137. [vi] Fulk, George D. et al. “The Impact of Sleep Disorders on Functional Recovery and Participation Following Stroke: A Systematic Review and Meta-Analysis.” Neurorehabilitation and neural repair 34.11 (2020): 1050–1061. [vii] Siengsukon, Catherine et al. “Sleep Parameters, Functional Status, and Time Post-Stroke Are Associated with Offline Motor Skill Learning in People with Chronic Stroke.” Frontiers in neurology 6 (2015): 225–225. [viii] KANEKO, Yasuyuki et al. “Relationship of Sleep Apnea to Functional Capacity and Length of Hospitalization Following Stroke.” Sleep (New York, N.Y.) 26.3 (2003): 293–297.