Sleep and stroke

Sleep–wake functions and respiration depend upon the integrity of neuronal networks in the brainstem and cerebral hemispheres. Following stroke, sleep–wake disorders (SWDs) and sleep-disordered breathing (SDB) are frequently observed as a direct or indirect (e.g., pain, depression, medications) consequence of acute focal brain damage. About one-third of stroke patients present with SWD – mostly as insomnia or hypersomnia (excessive daytime sleepiness, fatigue, increased sleep needs). Severe SWDs are often seen after thalamic or brainstem stroke, are linked with neuropsychiatric and psychological deficits, and have a less favorable functional outcome. The relationship between stroke characteristics (topography, severity, outcome), sleep electroencephalographic changes and SWD is complex. In severe/persisting SWD, hypnotics, dopaminergic drugs, and stimulants can be used. About half of patients have SDB, mostly in the form of obstructive sleep apnea (OSA). OSA represents both a risk factor and a consequence of stroke. The presence of OSA has been linked with poorer outcome. Continuous positive airway pressure is the treatment of choice for OSA. Oxygen and other forms of ventilation may be helpful in central forms of SDB.