Sleep disorders and the risk of stroke

ABSTRACT

Introduction: Stroke is a major cause of disability and death in the United States and across the world, and the incidence and prevalence of stroke are expected to rise significantly due to an aging population. Obstructive sleep apnea, an established independent risk factor for stroke, is a highly prevalent disease that is estimated to double the risk of stroke. It remains uncertain whether non-apnea sleep disorders increase the risk of stroke.

Areas covered: This paper reviews the literature describing the association between incident stroke and sleep apnea, rapid eye movement sleep behavior disorder, restless legs syndrome, periodic limb movements of sleep, insomnia, and shift work.

Expert commentary: Trials of continuous positive airway pressure for stroke prevention in sleep apnea patients have been largely disappointing, but additional trials that target populations not yet optimally studied are needed. Self-reported short and long sleep duration may be associated with incident stroke. However, abnormal sleep duration may be a marker of chronic disease, which may itself be associated with incident stroke. The relationship between non-apnea sleep disorders and incident stroke deserves further attention. Identification of specific non-apnea sleep disorders or sleep problems that convey an increased risk for stroke may provide novel targets for stroke prevention.

KEYWORDS:

• Sleep-disordered breathing
• sleep apnea
• stroke
• restless legs syndrome
• REM sleep behavior disorder
• sleep duration

Declaration of interest

DL Brown is funded by NIH grants (R01HL123379, R01HL126700, U10NS086526, R01MD011516). RD Chervin receives support from NIH grants (R01HL123379, R01HL126700, R01HL05999, TT32HL110952). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Devin L. Brown is funded by NIH grants R01HL123379, R01HL126700, U10NS086526, and R01MD011516. Ronald D. Chervin receives support through R01HL123379, R01HL126700, R01HL105999, and T32HL110952.