Stroke during sleep symptoms
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Stroke During Sleep: Symptoms and Implications
Introduction to Stroke and Sleep
Strokes occurring during sleep can be particularly insidious, as the symptoms may not be immediately recognized. Understanding the relationship between sleep disturbances and stroke is crucial for both prevention and management. This article synthesizes current research on the symptoms and implications of stroke during sleep.
Excessive Daytime Sleepiness (EDS) and Stroke
Excessive daytime sleepiness (EDS) is a common symptom among stroke survivors and can significantly impact their quality of life and cognitive functioning. EDS is often linked to sleep-disordered breathing, depression, and other post-stroke complications. The lack of a universally accepted definition of EDS complicates its measurement and the synthesis of research findings. However, it is clear that EDS is a multidimensional construct that requires both subjective and objective measures for comprehensive understanding.
Sleep Disorders as Risk Factors and Consequences of Stroke
Sleep disorders are increasingly recognized as both risk factors for stroke and consequences of stroke. Conditions such as sleep-disordered breathing, insomnia, narcolepsy, and periodic limb movements during sleep are prevalent among stroke patients and can worsen stroke outcomes. Post-stroke sleep disturbances are associated with poorer recovery and increased mortality, highlighting the importance of screening and treating these conditions.
Sleep Patterns and Acute Stroke Risk
Research indicates that various sleep disturbances, including short and long sleep durations, impaired sleep quality, and sleep apnea, are significantly associated with an increased risk of acute stroke. For instance, short sleep (<5 hours) and long sleep (>9 hours) have been linked to higher odds of stroke. Additionally, symptoms like snoring, snorting, and breathing cessation during sleep are strong predictors of stroke risk.
Prevalence of Sleep Disorders Post-Stroke
The prevalence of sleep disorders remains high across different phases following a stroke or transient ischemic attack (TIA). Sleep-disordered breathing, insomnia, and periodic limb movements during sleep are common in the acute, subacute, and chronic phases post-stroke. For example, more than 50% of stroke patients experience sleep-disordered breathing, which can spontaneously improve but often requires treatment such as continuous positive airway pressure (CPAP).
Impact of Sleep Disorders on Stroke Outcomes
Severe obstructive sleep apnea (OSA) doubles the risk of incident stroke, particularly in younger patients. CPAP treatment may reduce stroke risk and improve outcomes, especially in compliant patients. Insomnia and periodic limb movements in sleep (PLMS) are also associated with increased stroke risk and poorer recovery outcomes, although the evidence is less robust compared to OSA.
Sleep Disturbances and Stroke Severity
Pre-morbid sleep disturbances are associated with increased stroke severity and poorer functional outcomes. Patients with multiple sleep disturbance symptoms are more likely to experience severe strokes and functional deterioration within a month post-stroke. This underscores the need for interventions targeting sleep disturbances to prevent disabling strokes and improve recovery.
Conclusion
Sleep disturbances are both a significant risk factor for stroke and a common consequence of stroke. Conditions such as EDS, sleep-disordered breathing, and insomnia not only increase the risk of stroke but also worsen recovery outcomes. Early screening and treatment of sleep disorders in stroke patients are essential for improving their prognosis and quality of life. Future research should focus on the efficacy of sleep interventions in stroke prevention and recovery.
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