Insomnia and sleep apnea appear to increase stroke risk, finds a review study published online Wednesday in the journal Neurology. Because of this link, researchers say, anyone who’s had a stroke or a transient ischemic attack—also called a mini-stroke or TIA—should be screened for undiagnosed sleep disorders.
The new review looked at several dozen studies that included tens of thousands of patients with sleep disorders, including obstructive sleep apnea, excessive daytime sleepiness, insomnia, restless leg syndrome, and REM sleep behavior disorder. These conditions are common in stroke patients, the authors wrote, and research suggests that they are both contributing factors and also consequences of stroke.
Overall, the researchers found strong evidence that sleep-disordered breathing conditions (including sleep apnea) increased the risk of stroke and TIA. They also made healing from a stroke more difficult: Some studies found a higher risk of death or another cardiovascular event in recovering patients with sleep breathing problems, while others found higher blood pressure, slower neurologic recovery, and longer hospital stays.
Disorders that affect how much time a person actually spends asleep—such as insomnia, restless leg syndrome, excessive sleep, or excessive daytime sleepiness—may increase stroke risk and harm recovery, as well, the researchers concluded, although the evidence wasn’t as strong for these conditions.
These findings are important, say the study authors, because doctors don’t always make the connection between sleep problems and stroke.
“Although sleep disorders are common after a stroke, very few stroke patients are tested for them,” said co-author Dirk M. Hermann, MD, of University Hospital Essen in Essen, Germany, in a press release. “The results of our review show that should change, as people with sleep disorders may be more likely to have another stroke or other negative outcomes than people without sleep problems, such as having to go to a nursing home after leaving the hospital.”
Getting screened and diagnosed can mean getting proper treatment. For sleep apnea patients, says Hermann, that means being prescribed a continuous positive airway pressure (CPAP) machine. Evidence shows that using these devices—which are worn at night and force air through the nose and into the airways, keeping the throat from closing up—can help people stay healthier after suffering a stroke.
Losing weight should also help to improve sleep-disordered breathing, the study notes. Being cautious with alcohol use, which can negatively affect breathing during sleep, is also recommended.
The authors weren’t as supportive of using medications, such as hypnotics, sedatives, stimulants, and benzodiazepines, for sleep-wake disorders. “Treatment is relevant for stroke recovery and outcome,” they write, “but should be used thoughtfully considering potential side effects.”
The bottom line? If you’ve been diagnosed with a sleep disorder or suspect that you might have one, talk to your doctor about treatment, and about how you can protect yourself from stroke. And if you or a loved one has had a stroke, make sure you’re screened—and treated, if necessary—for hidden sleep problems that may be affecting your health.