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Management of Sleep Disorders in Stroke

  • Sleep Disorders
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Opinion statement

Scientific studies have proven a very strong association between stroke and obstructive sleep apnea (OSA). The prevalence of OSA is very high in patients with acute stroke, and untreated OSA is a stroke risk factor. In the stroke patient population, symptoms of OSA may atypically appear as isolated insomnia, hypersomnia, a dysfunction of circadian rhythm, a parasomnia, or a sleep-related movement disorder. Thus, we believe that in patients with acute stroke, OSA should be addressed first, using full in-laboratory, attended polysomnography (PSG), before other specific sleep disorders are aggressively addressed with specific therapeutic interventions. When OSA is diagnosed, supportive techniques including the application of continuous positive airway pressure (CPAP) therapy, positional therapies, or both should be considered first-line treatments. If OSA is ruled out by PSG, the therapeutic emphasis for sleep-related complaints is routinely based on instituting good sleep hygiene practices and using cognitive behavioral techniques (cognitive therapies, sleep restriction, stimulus control, and progressive relaxation therapies) because patients with stroke may be prone to the adverse effects of many of the medications that are otherwise routinely prescribed for a variety of specific sleep disorders.

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Disclosure

Dr. Dyken has received research grants from Merck and Cephalon. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Departments of Internal Medicine and Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Kyoung Bin Im MD

  2. Clinical Neurophysiology, Department of Neurology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Scott Strader MD

  3. Neurology, Department of Neurology Sleep Disorders Center, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Mark Eric Dyken MD, FAHA, FAASM

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  1. Kyoung Bin Im MD
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  2. Scott Strader MD
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Correspondence to Mark Eric Dyken MD, FAHA, FAASM.

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Im, K.B., Strader, S. & Dyken, M.E. Management of Sleep Disorders in Stroke. Curr Treat Options Neurol 12, 379–395 (2010). https://doi.org/10.1007/s11940-010-0089-2

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