Sleep Problems in Stroke Survivors May Set Stage for Another Stroke

Stroke survivors suffering from sleep-wake disturbances are more likely to have another stroke or serious cardio- or cerebrovascular event compared to those without sleep disturbances, according to a new study.

The study found that having multiple sleep-wake disturbances, such as sleep-disordered breathing, extreme long or short sleep duration, insomnia, and restless leg syndrome independently and significantly increased the risk of a new cardio-cerebrovascular event such as a stroke, transient ischaemic attack, or myocardial infarction in the two years following a stroke.

This suggests that assessing and improving sleep patterns in stroke survivors could improve their long-term outcomes, according to the study, which was conducted by Professor Claudio Basssetti and his research team at the University Hospital of Bern in Switzerland.

“We know that people who have had a stroke often experience sleep disorders, and that these are associated with worse stroke recovery outcomes,” said Drs. Martijn Dekkers and Simone Duss from the University of Bern in Switzerland. “What we wanted to learn from this study was whether sleep-wake disturbances in particular are associated with worse outcomes after stroke.”

The study included 438 individuals aged 21 to 86 years — with an average age of 65 years — who had been hospitalized after an acute ischemic stroke (a type of stroke caused by a blocked blood vessel to the brain) or a transient ischaemic attack (a ‘mini-stroke’ caused by a brief blockage of the blood supply to the brain with transient clinical symptoms up to 24 hours).

The presence and severity of the sleep-wake disturbances, such as insomnia, restless leg syndrome, and sleep duration, as well as daytime symptoms such as sleepiness, were recorded for each individual at one, three, 12, and 24 months after their stroke, the researchers reported.

Sleep-disordered breathing was assessed within the first days after the ischemic stroke or transient ischemic attack using respirography, according to the researchers.

The occurrence of new cardio-cerebrovascular events was also recorded during the two years of follow-up.

According to the researchers, a bit more than one-third of the patients reported insomnia symptoms according to the Insomnia Severity Index questionnaire. About 8 percent fulfill the clinical diagnosis of restless legs syndrome, while 26 percent suffer from severe sleep-disordered breathing, such as sleep apnea. Additionally, about 15 percent reported extreme sleep durations, with a tendency toward longer sleep durations following the stroke.

“Using the sleep-related information we collected during the first three months after the stroke, we calculated a ‘sleep burden index’ for each individual, which reflected the presence and severity of sleep-wake disturbances,” explained Dekkers. “We then assessed whether the sleep burden index could be used to predict who would go on to have another cardio-cerebrovascular event during the two years we followed them after their stroke.”

The results suggest that stroke survivors with at least one subsequent cardio/cerebrovascular event have a higher sleep burden index score than patients without a subsequent event three months to two years post-stroke. Moreover, a high sleep burden index was associated with a higher risk for subsequent cerebro-cardiovascular events, the study discovered.

Although interventional trials investigating the benefit of treating sleep-wake-disturbances after stroke are needed, Duss said that sleep-wake disorders should be more systematically assessed and considered in comprehensive treatment approaches in stroke patients.

This follows recent guidelines produced by the European Academy of Neurology, in collaboration with three other European societies.

The study was presented at the European Academy of Neurology Virtual Congress in May 2020.

Source: Spink Health

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