Impact of Sleep Disorders and Disturbed Sleep on Brain Health: A Scientific Statement From the American Heart Association

Abstract

Accumulating evidence supports a link between sleep disorders, disturbed sleep, and adverse brain health, ranging from stroke to subclinical cerebrovascular disease to cognitive outcomes, including the development of Alzheimer disease and Alzheimer disease–related dementias. Sleep disorders such as sleep-disordered breathing (eg, obstructive sleep apnea), and other sleep disturbances, as well, some of which are also considered sleep disorders (eg, insomnia, sleep fragmentation, circadian rhythm disorders, and extreme sleep duration), have been associated with adverse brain health. Understanding the causal role of sleep disorders and disturbances in the development of adverse brain health is complicated by the common development of sleep disorders among individuals with neurodegenerative disease. In addition to the role of sleep disorders in stroke and cerebrovascular injury, mechanistic hypotheses linking sleep with brain health and biomarker data (blood-based, cerebrospinal fluid-based, and imaging) suggest direct links to Alzheimer disease–specific pathology. These potential mechanisms and the increasing understanding of the “glymphatic system,” and the recognition of the importance of sleep in poststroke recovery, as well, support a biological basis for the indirect (through the worsening of vascular disease) and direct (through specific effects on neuropathology) connections between sleep disorders and brain health. Given promising evidence for the benefits of treatment and prevention, sleep disorders and disturbances represent potential targets for early treatment that may improve brain health more broadly. In this scientific statement, we discuss the evidence supporting an association between sleep disorders and disturbances and poor brain health ranging from stroke to dementia and opportunities for prevention and early treatment.

The Experience of Itch in Autistic Adults: An Online Survey

“…Differences found in both the impact on sleep and other daily activities provide support that itch experience is not simply better attended to by autistic people but a highly relevant component of their wellbeing. It is known that poor sleep directly impacts physical and mental health and one's ability to work (Blok et al, 2022;Dawson et al, 2021;Gottesman et al, 2024;Nistor et al, 2023), suggesting that unpleasant itch may have both direct and indirect effects on quality of life.…”

Stroke in the Time of Circadian Medicine

“…188,190,194 Furthermore, sleep disorders have been recognized as general risk factors for stroke, vascular cognitive impairment and other dementias. 195 A cohort study has alluded that the sleep-to-wake transition might be an independent risk factor for stroke occurrence. 191 While the morning peak occurs for major ischemic stroke subtypes including large artery atherosclerotic, cardioembolic and cryptogenic, lacunar strokes are more frequent at night from 00:00 to 06:00.…”

Associations of sleep disorders with all-cause MCI/dementia and different types of dementia – clinical evidence, potential pathomechanisms and treatment options: A narrative review

“…In human studies, especially SDB due to intermittent hypoxia leads to vascular changes including inflammation, oxidative stress, endothelial dysfunction and atherosclerosis (Foster et al, 2007). Further, insomnia/short sleep durations and SDB increase risk factors for (cerebro-)vascular diseases including hypertension, diabetes mellitus, depression, and increased activity of the stress system (cortisol, norepinephrine, and adrenocorticotropic hormone levels, sympathetic and central activitation including whole body and brain metabolism, heart rate and pupil size) (Vgontzas et al, 2013;Gottesman et al, 2024). SDB has also shown a cross-sectional association with the presence of white matter hyperintensity which is common in vascular dementia and stroke in the middle-aged and older general population even indepent from hypertension representing a major risk factor for (cerebro-) vascular disease (Kim et al, 2013;Chokesuwattanaskul et al, 2020).…”