Sleep stroke symptoms
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Sleep and Stroke Symptoms: Understanding the Connection
Sleep Disturbances as Risk Factors for Stroke
Short and Long Sleep Duration
Research indicates that both short sleep duration (less than 5 hours) and long sleep duration (more than 9 hours) are significantly associated with an increased risk of acute stroke. Short sleep duration has an odds ratio (OR) of 3.15, while long sleep duration has an OR of 2.67, suggesting that both extremes of sleep duration can elevate stroke risk.
Sleep Quality and Sleep Disorders
Impaired sleep quality, difficulty in falling asleep, and maintaining sleep are also linked to higher stroke risk. Specifically, impaired sleep quality has an OR of 1.52, while difficulty in falling asleep and maintaining sleep have ORs of 1.32 and 1.33, respectively. Additionally, sleep disorders such as obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) are prevalent among stroke survivors and are considered independent risk factors for stroke .
Sleep-Related Breathing Disorders
Sleep-related breathing disorders, particularly OSA, are common in stroke patients. OSA is present in 50-70% of stroke patients and is associated with poorer long-term outcomes and increased stroke mortality. Continuous positive airway pressure (CPAP) is the recommended treatment for OSA, which can help mitigate these risks .
Post-Stroke Sleep Symptoms
Excessive Daytime Sleepiness (EDS)
EDS is a frequent symptom among stroke survivors and can significantly reduce their quality of life, cognitive functioning, and daytime performance. The lack of a universally accepted definition of EDS complicates its measurement, but it is generally recognized as a multidimensional construct that can be assessed using both subjective and objective measures.
Insomnia and Sleep-Wake Disorders
Insomnia and other sleep-wake disorders, such as hypersomnia and fatigue, are also common post-stroke. The prevalence of insomnia in stroke survivors is significantly higher compared to the general population, with a pooled prevalence of 38.2%. These disorders are associated with cognitive disturbances and can compromise neurological recovery.
Functional Outcomes and Sleep Health
Sleep disturbances after ischemic stroke, including alterations in sleep architecture and disorders like restless legs syndrome, can impact functional outcomes. Poor sleep health is associated with worse clinical outcomes at three months post-stroke, including lower scores on the Barthel Index and modified Rankin score.
Screening and Treatment
Screening for Sleep Disorders
Given the high prevalence of sleep disorders in stroke patients, screening for conditions like OSA and insomnia is crucial. Tools such as the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scale and the Insomnia Severity Index (ISI) can be effective in identifying patients at risk.
Treatment Interventions
Treatment options for sleep disorders in stroke patients include CPAP for OSA, dopaminergic drugs for restless legs syndrome, and modafinil for excessive daytime sleepiness. However, the use of hypnotics and sedative antidepressants should be approached with caution as they may aggravate sleep-disordered breathing and hinder neurological recovery .
Conclusion
Sleep disturbances are both a risk factor for and a consequence of stroke. Addressing these disturbances through proper screening and treatment can potentially reduce stroke risk and improve outcomes for stroke survivors. Further research is needed to explore the efficacy of sleep interventions in stroke prevention and recovery.
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