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 The authors recommend screening for these sleep disorders among
people who have had a stroke or mini-stroke.
“We have been aware in neurology for a couple of years already that
breathing disturbances are a risk factor for stroke,” said coauthor
Dr. Dirk M. Hermann of University Hospital Essen in Essen, Germany.
“Sleep has restorative functions for the brain and is important for
storing information we collect during the night, which explains why
stroke recovery is so much affected by sleep disturbances,” he said.
But in stroke treatment and recovery, treating acute issues tends to
take precedent over sleep studies, Hermann told Reuters Health.
In 29 studies of what’s known as sleep disordered breathing, such as
sleep apnea, the researchers found that breathing issues tend to
precede a stroke and are often tied to strokes that happen during
sleep.
Hypersomnia, or sleeping too much, mostly emerges after a stroke,
and may resolve in a few months but overall fatigue can last for
years, the researchers report in Neurology.
Insomnia is also common for stroke survivors, and in most cases it
was an issue for patients before the stroke occurred.
In two studies, more than 10 percent of stroke survivors experienced
restless leg syndrome within one month of their stroke. Stroke
survivors with restless leg syndrome were also more likely than
others to have diabetes.
More than half of stroke patients have some sleep disordered
breathing issue, like sleep apnea, before their stroke, and treating
the issue with a continuous positive airway pressure (CPAP) machine
reduces stroke risk and improves outcomes after a stroke, the
researchers write.
People who suffer a stroke should be screened for any sleep
problems, and sleep apnea should be treated. There is less evidence
that treating sleep-wake disorders like insomnia or sleeping too
much with medications improves stroke recovery, they conclude.
People, especially doctors, should be aware of the link between
sleep issues and stroke, Hermann said.
“We have to consider that we have quite good ways of diagnosing
sleep disturbances and effective means of treating them,” he said.
It’s up to national associations to define which way it is most
appropriate to integrate sleep screening and treatment into stroke
care, he said.
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“Typical post-stroke workup involves testing for many risk factors
including carotid atherosclerosis, atrial fibrillation,
hypercoagulable states, hypertension, high cholesterol, and diabetes
among others,” said Karin Johnson, medical director of Baystate
Health Regional Sleep Program in Greenfield, Massachusetts, who was
not part of the new study.
“Obstructive sleep apnea not only worsens all of these conditions
but even with adjusting for other causes doubles the risk of
stroke,” but many people are not currently tested for obstructive
sleep apnea after having a stroke, Johnson told Reuters Health by
email.
“Even if someone has normal good quality sleep, just being sleep
deprived can also increase the risk of stroke and other
cardiovascular conditions like heart attacks so for most people
trying to get at least 7 hours of sleep a night is the best to give
enough sleep to protect and strengthen our body,” said Johnson, who
is also an assistant professor of neurology at University of
Massachusetts Medical School in Worcester.
If you have loud snoring, frequent urination at night, gasping
arousals, disrupted sleep, unrefreshing sleep, daytime sleepiness or
fatigue, or no symptoms but signs like difficult to control high
blood pressure, a large neck, and obesity, ask you doctors to test
you for sleep apnea so you can get treated early before other
complications arise, she said.
SOURCE: http://bit.ly/2aEaqjz Neurology, online August 3, 2016.
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