Sleep Disturbances as a Risk Factor for Stroke

Koo, Dae Lim; Nam, Hyunwoo; Thomas, Robert J.; Yun, Chang Ho

doi:10.5853/jos.2017.02887

Cited by 107 publications

(95 citation statements)

References 237 publications

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“…Other SWD such as extremes of sleep duration (short and long sleep) as well as circadian rhythm disorders (e.g. related to shift work) have been linked to cardiovascular diseases, such as stroke, and have been suggested to negatively influence their course and outcome [26][27][28][29][30][31][32][33][34][35].…”

Section: Introductionmentioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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Section: Introductionmentioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…O ptimum quality and quantity of sleep regulates our core biological functions. 1,2 Although the amount of time a person is engaged in sleep is important, reaching the deep rejuvenating stages of sleep is essential for optimum health benefits. 1,2 Sleep quality reflects how well a person is able to fall asleep, cycle through the various stages of sleep, and stay in those sleep stages for their full duration.…”

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confidence: 99%

“…1,2 Although the amount of time a person is engaged in sleep is important, reaching the deep rejuvenating stages of sleep is essential for optimum health benefits. 1,2 Sleep quality reflects how well a person is able to fall asleep, cycle through the various stages of sleep, and stay in those sleep stages for their full duration. 1,2 Often, manifestations of poor sleep are misinterpreted as behavioral issues, cognitive dysfunction, and/or systemic health concerns that may present differently in children and adults.…”

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confidence: 99%

“…1,2 Sleep quality reflects how well a person is able to fall asleep, cycle through the various stages of sleep, and stay in those sleep stages for their full duration. 1,2 Often, manifestations of poor sleep are misinterpreted as behavioral issues, cognitive dysfunction, and/or systemic health concerns that may present differently in children and adults. 1,3,4 The National Sleep Foundation estimates that 50 to 70 million Americans are affected by chronic sleep disorders or sleep disruptions that can significantly affect health and safety.…”

mentioning

confidence: 99%

“…1,2 Often, manifestations of poor sleep are misinterpreted as behavioral issues, cognitive dysfunction, and/or systemic health concerns that may present differently in children and adults. 1,3,4 The National Sleep Foundation estimates that 50 to 70 million Americans are affected by chronic sleep disorders or sleep disruptions that can significantly affect health and safety. 5 The Centers for Disease Control and Prevention (CDC) has declared sleep deprivation a public health crisis.…”

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confidence: 99%

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Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

Schroeder

Gurenlian

2019

Clin Med Res

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Oral health practitioners routinely perform oral health assessments for the dental patient to determine if oral disease is present. Systemic health is often a contributor to oral health concerns. One area in particular that has a direct effect on oral structures and oral health is poor sleep quality and open mouth breathing. Sleep is a fundamental process of the human body, which regulates core biological functions. Sleep quality reflects a person's ability to fall asleep, stay asleep, and enter into the various rejuvenating sleep cycles for the full duration. A person who does not obtain quality sleep can exhibit a wide range of oral, systemic, and cognitive health problems. Obstructive sleep apnea, which historically has been considered an adult male disease, is being recognized more often in women children. Research suggests various oral malformations found in newborns and young children can manifest as obstructive sleep apnea in adults. Oral health professionals are in a position to recognize the relationship between sleep and health, identify sleep quality concerns in relation to oral health assessments, administer sleep quality assessments, and determine appropriate referrals for further sleep quality evaluation.

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Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood

Lee

Kim

et al. 2022

JAMA Netw Open

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IMPORTANCEObstructive sleep apnea (OSA) is associated with cognitive impairment and brain structural alterations, but longitudinal outcomes are understudied. OBJECTIVE To examine the associations of OSA with cognition and white matter (WM) integrity over a 4-year period. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted in a community-based adult population among participants who had both baseline (2011-2014) and 4-year follow-up (2015-2018) polysomnography, diffusion tensor imaging, and cognitive assessment data. Participants with neurological disorders, anomalous findings on brain magnetic resonance imaging, or inadequate quality of the evaluations were excluded. Data were analyzed from March to November 2021. EXPOSURES Participants were categorized depending on the presence vs absence of OSA at baseline and follow-up polysomnographic analysis. MAIN OUTCOMES AND MEASURES The main outcomes were proportional changes over a 4-year period in neuropsychological performance and WM integrity. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol-coding, Trail Making Test-A, and Stroop Test. WM integrity was assessed by fractional anisotropy, axial, and radial diffusivity. To examine interactions with age and sex, participants were subgrouped by age older than 60 years vs 60 years or younger and men vs women. RESULTS A total of 1998 individuals were assessed for eligibility, and 888 were excluded based on exclusion criteria, leaving 1110 participants (mean [SD] age, 58.0 [6.0] years; 517 [46.6%] men) for analysis, including 458 participants grouped as OSA-free, 72 participants with resolved OSA, 163 participants with incident OSA, and 417 participants with persistent OSA. Incident OSA was associated with altered WM integrity and with concomitant changes in sustained attention compared with participants without OSA (eg, change in Digit Symbol-coding test score, -3.2% [95% CI, -5.2% to -1.2%]). Participants with resolved OSA showed better visual recall at the follow-up (change in Visual Reproduction-immediate recall test, 17.5% [95% CI, 8.9% to 26.1%]; change in Visual Reproduction-delayed recall test, 33.1% [95% CI, 11.3% to 54.9%]), with concordant changes in diffusion parameters at the relevant anatomic areas. In the older group only (age >60 years), persistent OSA was associated with altered WM integrity and cognition (eg, Visual Reproductionrecognition test: β = −24.2 [95% CI, −40.7 to −7.7]). Sex also was associated with modifying the association of OSA with WM integrity of the left posterior internal capsule, the left genu of corpus callosum, and the right middle cerebellar peduncle only in men and with cognition only in women (eg, Visual Reproduction-immediate recall test: β = 33.4 [95% CI, 19.1 to 47.7]).

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Sleep Disturbances as a Risk Factor for Stroke

Cited by 107 publications

References 237 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Recognizing Poor Sleep Quality Factors During Oral Health Evaluations

Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood

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