Semin Neurol 2009; 29(4): 438-445
DOI: 10.1055/s-0029-1237121
© Thieme Medical Publishers

Sleep and Stroke

Antonio Culebras1
  • 1Department of Neurology, Upstate Medical University, Syracuse, New York
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
09. September 2009 (online)

ABSTRACT

Sleep affects brain function and may contribute to vascular cerebral pathology through a diversity of direct and indirect mechanisms. Circadian rhythm investigation shows increased incidence of stroke between 6 am and 12 noon. Risk factors for stroke such as high blood pressure, ischemic heart disease, and diabetes are modified by sleep and sleep apnea. Epidemiological studies have shown a dose–response relationship between the severity of sleep apnea and the odds ratio for development of systemic hypertension. There is now evidence of a causal relationship between sleep apnea and stroke. Following stroke, both in the acute and chronic stages, patients have a high prevalence of sleep apnea that reduces the potential for rehabilitation, further increases the risk of secondary stroke, and heightens mortality. Successful correction of sleep apnea with noninvasive positive airway pressure ventilation lowers mean blood pressure, and indirectly lowers the risk of stroke. Unfortunately, patients with stroke tolerate positive noninvasive ventilation poorly, and other means of correcting sleep apnea need to be investigated.

REFERENCES

  • 1 Marler J R, Price T R, Clark G L et al.. Morning increase in onset of ischemic stroke.  Stroke. 1989;  20(4) 473-476
  • 2 Marsh III E E, Biller J, Adams Jr H P et al.. Circadian variation in onset of acute ischemic stroke.  Arch Neurol. 1990;  47(11) 1178-1180
  • 3 Culebras A. Cerebrovascular disease and sleep.  Curr Neurol Neurosci Rep. 2004;  4(2) 164-169
  • 4 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;  328(17) 1230-1235
  • 5 Andreotti F, Davies G J, Hackett D R et al.. Major circadian fluctuations in fibrinolytic factors and possible relevance to time of onset of myocardial infarction, sudden cardiac death and stroke.  Am J Cardiol. 1988;  62(9) 635-637
  • 6 Tofler G H, Brezinski D, Schafer A I et al.. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death.  N Engl J Med. 1987;  316(24) 1514-1518
  • 7 Kim S J, Kuklov A, Kehoe R F, Crystal G J. Sleep-induced hypotension precipitates severe myocardial ischemia.  Sleep. 2008;  31(9) 1215-1220
  • 8 Argentino C, Toni D, Rasura M et al.. Circadian variation in the frequency of ischemic stroke.  Stroke. 1990;  21(3) 387-389
  • 9 Kario K, Pickering T G, Matsuo T, Hoshide S, Schwartz J E, Shimada K. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives.  Hypertension. 2001;  38(4) 852-857
  • 10 Loredo J S, Nelesen R, Ancoli-Israel S, Dimsdale J E. Sleep quality and blood pressure dipping in normal adults.  Sleep. 2004;  27(6) 1097-1103
  • 11 Giles T D. Circadian rhythm of blood pressure and the relation to cardiovascular events.  J Hypertens Suppl. 2006;  24(2) S11-S16
  • 12 Kario K, Ishikawa J, Pickering T G et al.. Morning hypertension: the strongest independent risk factor for stroke in elderly hypertensive patients.  Hypertens Res. 2006;  29(8) 581-587
  • 13 Javaheri S, Storfer-Isser A, Rosen C L, Redline S. Sleep quality and elevated blood pressure in adolescents.  Circulation. 2008;  118(10) 1034-1040
  • 14 Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function.  Lancet. 1999;  354(9188) 1435-1439
  • 15 Vgontzas A N, Papanicolaou D A, Bixler E O et al.. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia.  J Clin Endocrinol Metab. 2000;  85(3) 1151-1158
  • 16 Tuomilehto H, Peltonen M, Partinen M et al.. Sleep duration is associated with an increased risk for the prevalence of type 2 diabetes in middle-aged women - The FIN-D2D survey.  Sleep Med. 2008;  9(3) 221-227
  • 17 Gottlieb D J, Punjabi N M, Newman A B et al.. Association of sleep time with diabetes mellitus and impaired glucose tolerance.  Arch Intern Med. 2005;  165(8) 863-867
  • 18 Ayas N T, White D P, Al-Delaimy W K et al.. A prospective study of self-reported sleep duration and incident diabetes in women.  Diabetes Care. 2003;  26(2) 380-384
  • 19 Reaven G M, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities—the role of insulin resistance and the sympathoadrenal system.  N Engl J Med. 1996;  334(6) 374-381
  • 20 Lindberg E, Janson C, Gislason T, Svärdsudd K, Hetta J, Boman G. Snoring and hypertension: a 10 year follow-up.  Eur Respir J. 1998;  11(4) 884-889
  • 21 Koskenvuo M, Kaprio J, Telakivi T, Partinen M, Heikkilä K, Sarna S. Snoring as a risk factor for ischaemic heart disease and stroke in men.  Br Med J (Clin Res Ed). 1987;  294(6563) 16-19
  • 22 Palomäki H, Partinen M, Erkinjuntti T, Kaste M. Snoring, sleep apnea syndrome, and stroke.  Neurology. 1992;  42(7, Suppl 6) 75-81 discussion 82
  • 23 Partinen M, Palomäki H. Snoring and cerebral infarction.  Lancet. 1985;  2(8468) 1325-1326
  • 24 Kim J, Yi H, Shin K R, Kim J H, Jung K H, Shin C. Snoring as an independent risk factor for hypertension in the nonobese population: the Korean Health and Genome Study.  Am J Hypertens. 2007;  20(8) 819-824
  • 25 Lugaresi E, Coccagna G, Mantovani M, Cirignotta F, Ambrosetto G, Baturic P. Hypersomnia with periodic breathing: periodic apneas and alveolar hypoventilation during sleep.  Bull Physiopathol Respir (Nancy). 1972;  8(5) 1103-1113
  • 26 Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E. Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing.  Bull Physiopathol Respir (Nancy). 1972;  8(5) 1159-1172
  • 27 Narkiewicz K, Somers V K. The sympathetic nervous system and obstructive sleep apnea: implications for hypertension.  J Hypertens. 1997;  15(12 Pt 2) 1613-1619
  • 28 Nieto F J, Young T B, Lind B K et al.. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study.  JAMA. 2000;  283(14) 1829-1836
  • 29 Peppard P E, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension.  N Engl J Med. 2000;  342(19) 1378-1384
  • 30 Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study.  BMJ. 2000;  320(7233) 479-482
  • 31 Culebras A. REM-sleep related diaphragmatic insufficiency.  Neurology. 1998;  50(suppl 4) 393-394
  • 32 Okosun I S, Prewitt T E, Cooper R S. Abdominal obesity in the United States: prevalence and attributable risk of hypertension.  J Hum Hypertens. 1999;  13(7) 425-430
  • 33 Flemons W W, Remmers J E, Gillis A M. Sleep apnea and cardiac arrhythmias. Is there a relationship?.  Am Rev Respir Dis. 1993;  148(3) 618-621
  • 34 Guilleminault C, Connolly S J, Winkle R A. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome.  Am J Cardiol. 1983;  52(5) 490-494
  • 35 Mooe T, Gullsby S, Rabben T, Eriksson P. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery.  Coron Artery Dis. 1996;  7(6) 475-478
  • 36 Gami A S, Somers V K. Implications of obstructive sleep apnea for atrial fibrillation and sudden cardiac death.  J Cardiovasc Electrophysiol. 2008;  19(9) 997-1003
  • 37 Braga B, Poyares D, Cintra F et al.. Sleep-disordered breathing and chronic atrial fibrillation.  Sleep Med. 2009;  10(2) 212-216
  • 38 Stevenson I H, Teichtahl H, Cunnington D, Ciavarella S, Gordon I, Kalman J M. Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function.  Eur Heart J. 2008;  29(13) 1662-1669
  • 39 Gami A S, Hodge D O, Herges R M et al.. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation.  J Am Coll Cardiol. 2007;  49(5) 565-571
  • 40 Guilleminault C, Pool P, Motta J, Gillis A M. Sinus arrest during REM sleep in young adults.  N Engl J Med. 1984;  311(16) 1006-1010
  • 41 Culebras A. Stroke and sleep disorders. In: Fisher M, Bogousslavsky J Current Review of Cerebrovascular Disease. 2nd ed. Philadelphia; Current Medicine 1996
  • 42 Marin J M, Carrizo S J, Vicente E, Agusti A G. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.  Lancet. 2005;  365(9464) 1046-1053
  • 43 Valham F, Mooe T, Rabben T, Stenlund H, Wiklund U, Franklin K A. Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up.  Circulation. 2008;  118(9) 955-960
  • 44 Beelke M, Angeli S, Del Sette M et al.. Prevalence of patent foramen ovale in subjects with obstructive sleep apnea: a transcranial Doppler ultrasound study.  Sleep Med. 2003;  4(3) 219-223
  • 45 Netzer N, Werner P, Jochums I, Lehmann M, Strohl K P. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas.  Stroke. 1998;  29(1) 87-93
  • 46 Jiménez P E, Coloma R, Segura T. [Brain haemodynamics in obstructive sleep apnea syndrome].  Rev Neurol. 2005;  41(Suppl 3) S21-S24
  • 47 Sangal  R B, Sangal J M. Abnormal visual P300 latency in obstructive sleep apnea does not change acutely upon treatment with CPAP.  Sleep. 1997;  20 702-704
  • 48 Hill C M, Hogan A M, Onugha N et al.. Increased cerebral blood flow velocity in children with mild sleep-disordered breathing: a possible association with abnormal neuropsychological function.  Pediatrics. 2006;  118(4) e1100-e1108
  • 49 Hogan A M, Hill C M, Harrison D, Kirkham F J. Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy.  Pediatrics. 2008;  122(1) 75-82
  • 50 Yaggi H K, Concato J, Kernan W N, Lichtman J H, Brass L M, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death.  N Engl J Med. 2005;  353(19) 2034-2041
  • 51 Muñoz R, Durán-Cantolla J, Martínez-Vila E et al.. Severe sleep apnea and risk of ischemic stroke in the elderly.  Stroke. 2006;  37(9) 2317-2321
  • 52 Arzt M, Young T, Finn L, Skatrud J B, Bradley T D. Association of sleep-disordered breathing and the occurrence of stroke.  Am J Respir Crit Care Med. 2005;  172(11) 1447-1451
  • 53 Erkinjuntti T, Partinen M, Sulkava R, Telakivi T, Salmi T, Tilvis R. Sleep apnea in multiinfarct dementia and Alzheimer's disease.  Sleep. 1987;  10(5) 419-425
  • 54 Harbison J, Ford G A, James O F, Gibson G J. Sleep-disordered breathing following acute stroke.  QJM. 2002;  95(11) 741-747
  • 55 Bassetti C, Aldrich M S. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients.  Sleep. 1999;  22(2) 217-223
  • 56 Iranzo A, Santamaría J, Berenguer J, Sánchez M, Chamorro A. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction.  Neurology. 2002;  58(6) 911-916
  • 57 Bassetti C L, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome.  Stroke. 2006;  37(4) 967-972
  • 58 Turkington P M, Allgar V, Bamford J, Wanklyn P, Elliott M W. Effect of upper airway obstruction in acute stroke on functional outcome at 6 months.  Thorax. 2004;  59(5) 367-371
  • 59 Giubilei F, Iannilli M, Vitale A et al.. Sleep patterns in acute ischemic stroke.  Acta Neurol Scand. 1992;  86(6) 567-571
  • 60 Vingerhoets F, Bogousslavsky J. Respiratory dysfunction in stroke.  Clin Chest Med. 1994;  15(4) 729-737
  • 61 Broadley S A, Jørgensen L, Cheek A et al.. Early investigation and treatment of obstructive sleep apnoea after acute stroke.  J Clin Neurosci. 2007;  14(4) 328-333
  • 62 Brown D L, Lisabeth L D, Zupancic M J, Concannon M, Martin C, Chervin R D. High prevalence of supine sleep in ischemic stroke patients.  Stroke. 2008;  39(9) 2511-2514
  • 63 Alexandrov A V, Sharma V K, Lao A Y, Tsivgoulis G, Malkoff M D, Alexandrov A W. Reversed Robin Hood syndrome in acute ischemic stroke patients.  Stroke. 2007;  38(11) 3045-3048
  • 64 Pepperell J CT, Ramdassingh-Dow S, Crosthwaite N et al.. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial.  Lancet. 2002;  359(9302) 204-210
  • 65 Becker H F, Jerrentrup A, Ploch T et al.. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea.  Circulation. 2003;  107(1) 68-73
  • 66 Good D C, Henkle J Q, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke.  Stroke. 1996;  27(2) 252-259
  • 67 Dyken M E, Somers V K, Yamada T, Ren Z Y, Zimmerman M B. Investigating the relationship between stroke and obstructive sleep apnea.  Stroke. 1996;  27(3) 401-407
  • 68 Mohsenin V, Valor R. Sleep apnea in patients with hemispheric stroke.  Arch Phys Med Rehabil. 1995;  76(1) 71-76
  • 69 Parra O, Arboix A, Bechich S et al.. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack.  Am J Respir Crit Care Med. 2000;  161(2 Pt 1) 375-380
  • 70 Sahlin C, Sandberg O, Gustafson Y et al.. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up.  Arch Intern Med. 2008;  168(3) 297-301
  • 71 Hsu C Y, Vennelle M, Li H Y, Engleman H M, Dennis M S, Douglas N J. Sleep-disordered breathing after stroke: a randomised controlled trial of continuous positive airway pressure.  J Neurol Neurosurg Psychiatry. 2006;  77(10) 1143-1149
  • 72 Palombini L, Guilleminault C. Stroke and treatment with nasal CPAP.  Eur J Neurol. 2006;  13(2) 198-200

Antonio CulebrasM.D. 

Professor of Neurology, Upstate Medical University

750 E. Adams Street, Syracuse, NY 13210

eMail: aculebras@aol.com