Sleep and stroke

Introduction
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By Sheldon Kapen MD

In this clinical summary, Dr. Sheldon Kapen of Wayne State University highlights the importance of obstructive sleep apnea as a risk factor for stroke and the effectiveness of continuous positive airway pressure in preventing vascular morbidity and mortality in patients with transient ischemic attacks and stroke. In addition, rehabilitation and recovery are less successful in the presence of sleep apnea. Both sleep apnea and isolated snoring enhance carotid stenosis due to atherosclerosis. Finally, habitual short and long sleep durations, long-standing night shift work, and periodic leg movements of sleep negatively affect cerebrovascular morbidity and mortality.

Key Points

  • Sleep disorders are present in a large majority of acute stroke patients.
  • Obstructive sleep apnea is the most common sleep disorder and is an important risk factor for acute stroke or transient ischemic attack.
  • Central sleep apnea is also a risk factor for ischemic stroke.
  • All stroke and transient ischemic attack patients should be screened for sleep disorders and should be considered for treatment with CPAP.
  • Treatment of sleep apnea, if present, lowers the incidence of vascular morbidity and mortality.