Stroke while sleeping symptoms

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Symptoms and Risk Factors of Stroke While Sleeping

Introduction to Stroke and Sleep

Strokes occurring during sleep are a significant concern, as they can go unnoticed for hours, delaying critical treatment. Understanding the symptoms and risk factors associated with strokes that occur during sleep is crucial for early detection and prevention.

Common Symptoms of Stroke During Sleep

Sudden Awakening with Symptoms

One of the primary indicators of a stroke during sleep is waking up with symptoms that were not present before going to bed. These symptoms can include sudden numbness or weakness, particularly on one side of the body, confusion, trouble speaking or understanding speech, and severe headache with no known cause.

Sleep-Related Breathing Disorders

Sleep-disordered breathing (SDB), particularly obstructive sleep apnea (OSA), is prevalent among stroke patients and can be both a risk factor and a consequence of stroke. SDB is characterized by repeated episodes of partial or complete obstruction of the airway during sleep, leading to disrupted sleep and reduced oxygen levels . Symptoms of SDB include loud snoring, choking or gasping during sleep, and excessive daytime sleepiness .

Insomnia and Sleep-Wake Disturbances

Insomnia and other sleep-wake disturbances (SWD) are also common in stroke patients. These disturbances can manifest as difficulty falling asleep, frequent awakenings during the night, and excessive daytime sleepiness. Insomnia is reported in a significant proportion of stroke survivors, with prevalence rates ranging from 35.9% to 42.6% in different phases post-stroke .

Risk Factors for Stroke During Sleep

Sleep Disorders as Risk Factors

Several sleep disorders are identified as risk factors for stroke. These include:

Obstructive Sleep Apnea (OSA): Severe OSA doubles the risk of incident stroke, particularly in young to middle-aged patients. Continuous positive airway pressure (CPAP) therapy may reduce this risk.
Insomnia: While the direct link between insomnia and stroke risk is less clear, pharmacotherapy for insomnia may increase stroke risk.
Periodic Limb Movements in Sleep (PLMS): PLMS, but not restless leg syndrome (RLS), may be associated with an increased risk of stroke.

Pre-Morbid Sleep Disturbances

Pre-morbid sleep disturbances, such as difficulty falling asleep, poor sleep quality, and frequent awakenings, are associated with an increased risk of severe stroke and poorer functional outcomes. A higher number of sleep disturbance symptoms correlates with a greater likelihood of severe stroke and functional deterioration.

Stroke Etiology and Sleep

The type of stroke can influence whether it occurs during sleep. Lacunar infarctions, a type of ischemic stroke, are more likely to occur during sleep compared to other stroke subtypes like intracerebral hemorrhage and cardioembolic stroke.

Conclusion

Strokes during sleep present unique challenges due to delayed recognition and treatment. Symptoms such as sudden awakening with neurological deficits, sleep-disordered breathing, and insomnia are critical indicators. Understanding the risk factors, including various sleep disorders and pre-morbid sleep disturbances, can aid in early detection and prevention strategies. Further research is needed to explore the efficacy of sleep interventions in reducing stroke risk and improving outcomes for stroke survivors.