Nervenheilkunde 2016; 35(02): 13-18
DOI: 10.1055/s-0037-1616352
Kompetenznetz Schlaganfall
Schattauer GmbH

Schlafstörungen nach Schlaganfall

Post-stroke sleep disorders
F. Salih
1   Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin
,
P. Grosse
1   Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

eingegangen am: 21 September 2015

angenommen am: 23 September 2015

Publication Date:
10 January 2018 (online)

Zusammenfassung

Zu den häufigsten Schlafstörungen nach einem Schlaganfall zählen die schlafbezogenen Atmungsstörungen (ca. 70%), die Schlaf-Wach-Störungen (10% bis 50%) und die schlafbezogenen Bewegungsstörungen (ca. 10%). Schlafstörungen verschlechtern in unterschiedlichem Ausmaß das funktionelle Outcome nach einem Schlaganfall, erhöhen das Rezidivrisiko, fördern die Entwicklung weiterer vaskulärer Risikofaktoren (z. B. arterielle Hypertonie, Vorhofflimmern) und steigern die Mortalität. Die Erkennung von Schlafstörungen nach einem Schlaganfall ist somit eine wichtige Voraussetzung, um die Akutphase angemessen zu begleiten, die Rehabilitation zu optimieren und die Effektivität der Sekundärprophylaxe zu befördern. Oft kann schon eine gezielte Anamnese orientiert an spezifischen Fragebögen und die Analyse des kardiorespiratorischen Stroke-Monitorings wertvolle Hinweise auf das Vorliegen einer schlafbezogenen Atmungsstörung, einer Schlaf-Wach-Störung oder einer schlafbezogenen Bewegungsstörung liefern. Die vorliegende Übersicht fasst die aktuelle Studienlage zusammen und gibt pragmatische Empfehlungen, wie relevante Schlafstörungen bei Schlaganfall-Patienten identifiziert und behandelt werden können.

Summary

Various sleep disorders may impair functional outcome of patients with stroke. Additionally, sleep disorders increase the risk for further strokes and entertain other vascular risk factors like arterial hypertension and atrial fibrillation. Sleep disorders may also increase post-stroke mortality. The most common post-stroke sleep disorders are sleep-related breathing disorders (prevalence: ~70%), sleep-wake disorders (prevalence: 10% to 50%) and sleep-related movement disorders (prevalence: ~10%). Thus to recognize post-stroke sleep disorders is of major importance to decrease post-stroke impairment and to foster post-stroke rehabilitation and the effectiveness of vascular prevention. Consequently, in all patients with stroke a sleep-related patient´s history should be taken and specialized questionnaires be used to identify sleep disorders and to discriminate between them. This review summarizes current research and provides state-of-the-art recommendation for the diagnostic and therapeutic management of post-stroke sleep related disorders.

 
  • Literatur

  • 1 Claudio L. Bassetti. Sleep and Stroke. In: Principles and practice in sleep medicine. 5th edition. Meir H, Kryger PhD Thomas Roth, William C. (eds.) Dement. München: Elsevier; 2011: 993-1115.
  • 2 Hermann DM, Bassetti CL. Sleep-related breathing and sleep-wake disturbances in ischemic stroke. Neurology 2009; 73: 1313-22.
  • 3 Staub F, Bogousslavksy J. Fatigue after stroke: a major but neglected issue. Cerebrovasc Dis 2001; 12: 75-81.
  • 4 Siegnsukon CF, Boyd LA. Sleep enhances implicit motor skill learning in individuals poststroke. Top Stroke Rehabil 2008; 15: 1-12.
  • 5 Siengsukon CF, Boyd LA. Sleep to learn after stroke: implicit and explicit off-line motor learning. Neurosci Lett 2009; 451: 1-5.
  • 6 Medeiros CA, de Bruin PF, Paiva TR, Coutinho WM, Ponte RP, de Bruin VM. Clinical outcome after acute ischaemic stroke: the influence of restless legs syndrome. Eur J Neurol 2011; 18: 144-9.
  • 7 Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, Franklin KA. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 2008; 168: 297-301.
  • 8 Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005; 172: 1447-51.
  • 9 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353: 2034-41.
  • 10 Munoz R, Duran-Cantolla J, Martinez-Vila E. et al. Sever sleep apnea and risk of ischemic stroke in the elderly. Stroke 2005; 37: 2317-2321.
  • 11 Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep-apnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-1053.
  • 12 Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342: 1378-84.
  • 13 Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep HeartHealth Study. JAMA 2000; 283: 1829-36.
  • 14 Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S. Sleep Heart Health Study. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173: 910-6.
  • 15 Marin JM, Agusti A, Villar I. et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 2012; 307: 2169-76.
  • 16 Garcia-Touchard A, Somers VK, Olson LJ. et al. Central sleep apnea: implications for congestive heart failure. Chest 2008; 133: 1495-504.
  • 17 Bitter T, Langer C, Vogt J. et al. Sleep-disordered breathing in patients with atrial fibrillation and normal systolic left ventricular function. Dtsch Arztebl Int 2009; 106: 164-70.
  • 18 Leung RS, Huber MA, Rogge T. et al. Association between atrial fibrillation and central sleep apnea. Sleep 2005; 28: 1543-6.
  • 19 Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a metaanalysis. J Clin Sleep Med 2010; 15: 131-137.
  • 20 Siccoli M, Valko PO, Hermann DM, Bassetti CL. Central periodic breathing in 74 patients with acute ischemic stroke – neurogenic vs cardiogenic factors. J Neurol 2008; 255: 1687-1692.
  • 21 Adams HP, Bendixen BH, Kappelle LJ. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke 1993; 24: 35-41.
  • 22 Brown DL, Mowla A, McDermott M, Morgenstern LB, Hegeman G, Smith MA, Garcia NM, Chervin RD, Lisabeth LD. Ischemic stroke subtype and presence of sleep-disordered breathing: the BASIC sleep apnea study. J Stroke Cerebrovasc Dis 2015; 24: 388-93.
  • 23 Chaudhary BA, Elguindi A, Kinf DW. Obstructive sleep apnea after lateral medullary syndrome. South Med J 1982; 75: 65-67.
  • 24 Morrell MJ, Heywood P, Moosawi SH. et al. Unilateral focal lesions in the rostral medulla influence chemosensitivity and breathing measured during wakefulness, sleep, and exercise. J Neurol Neurosurg Psychiatry 1999; 67: 637-645.
  • 25 Bassetti C, Aldrich MS, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial stroke. Stroke 1997; 28: 1765-1772.
  • 26 Nopmaneejumruslers C, Kaneko T, Hajek V. et al. Cheyne-Stokes respiration in stroke. Am J Resp Crit Care Med 2005; 171: 1048-1052.
  • 27 Rowat AM, Wardlaw JM, Dennis MS. Abnormal breathing patterns in stroke: relationship with location of acute stroke lesion and prior cerebrovascular disease. J Neurol Neurosurg Psychiatry 2007; 78: 277-279.
  • 28 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 Resp Crit Care Med 2000; 161: 375-380.
  • 29 Bassetti C, Milanova M, Gugger M. Sleep disordered breathing and acute stroke: diagnosis, risk factors, treatment, and long-term outcome. Stroke 2006; 37: 967-972.
  • 30 American Academy for Sleep Medicine. The AASM Manual for the scoring of sleep and associated events. Rules, terminology and technical specifications. Westchester: American Academy for Sleep Medicine; 2007
  • 31 Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N. et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized parallel trial. Lancet 2001; 359: 204-210.
  • 32 Haentjens P, Van Meerhaeghe A, Moscariello A. et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 2007; 167: 757-64.
  • 33 Kanagala R, Murali NS, Friedman PA. et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003; 107: 2589-94.
  • 34 Fein AS, Shvilkin A, Shah D, Haffajee CI, Das S, Kumar K, Kramer DB, Zimetbaum PJ, Buxton AE, Josephson ME, Anter E. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol 2013; 62: 300-5.
  • 35 Giles TL, Lasserson TJ, Smith BH. et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2008
  • 36 Nachtmann A, Siebler M, Rose G. et al. Cheyne-Stokes respiration in ischemic stroke. Neurology 1995; 45: 820-821.
  • 37 Wessendorf TE, Wang YM, Thilmann AF. et al. Treatment of obstructive sleep apnoea with nasal continuous positive airway pressure. Eur Respir J 2001; 18: 623-629.
  • 38 Salih F, Grosse P. Schlafbezogene Atmungsstörungen. In: Komplikationen und Folgeerkrankungen nach Schlaganfall: Diagnostik und Therapie der frühen und späten klinischen Funktion-seinschränkungen. Jungehülsing GJ, Endres M. (Hrsg.) Stuttgart: Thieme; 2015
  • 39 Netzer NC, Stoohs RA, Netzer CM. et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131: 485-91.
  • 40 Park JY, Chun MH, Kang SH. et al. Functional outcome in poststroke patients with or without fatigue. Am J Phys Med Rehabil 2009; 88: 554-558.
  • 41 Leppävuori A, Pohjasvaara T, Vataja R. et al. Insomnia in ischemic stroke patients. Cerebrovasc Dis 2002; 14: 90-97.
  • 42 Vgontzas AN, Liao D, Bixler EO. et al. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 2009; 32: 491-498.
  • 43 Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO. Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based study. Diabetes Care 2009; 32: 1980-5.
  • 44 Divani AA, Majidi S, Barrett AM, Noorbaloochi S, Luft AR. Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008. Stroke 2011; 42: 1821-5.
  • 45 Freemon FR, Salinas-Garcia RF, Ward JW. Sleep patterns in a patient with brainstem infarction involving the raphe nucleus. Electroencephalogr Clin Neurophysiol 1974; 36: 657-660.
  • 46 Bassetti CL, Valko P. Poststroke hypersomnia. Sleep Med Clinics 2006; 1: 139-155.
  • 47 Choi-Kwon S, Han SW, Kwon SU, Kim JS. Poststroke fatigue: characteristics and related factors. Cerebrovasc Dis 2005; 19: 84-90.
  • 48 Li Pi Shan RS, Ashworth NL. Comparison of lorazepam and zopiclone for insomnia in patients with stroke and brain injury: a randomized, crossover, double blind trial. Am J Phys Med Rehab 2004; 83: 421-427.
  • 49 Palomäki H, Berg AT, Meririnne E. et al. Complaints of poststroke insomnia and its treatment with mianserin. Cerebrovasc Dis 2003; 15: 56-62.
  • 50 Choi-Kwon S, Choi J, Kwon SU, Kang DW, Kim JS. Fluoxetine is not effective in the treatment of poststroke fatigue: a double-blind, placebo-controlled study. Cerebrovasc Dis 2007; 23: 103e108.
  • 51 De Groot MH, Philipps SJ, Eskes GA. Fatigue associated with stroke and other neurologic conditions: implications for stroke rehabilitation. Arch Phys Med Rehab 2003; 84: 1714-1720.
  • 52 Lee SJ, Kim JS, Song IU. et al. Poststroke restless legs syndrome and lesion location: anatomical considerations. Mov Disord 2008; 24: 77-84.
  • 53 Xi Z, Luning W. REM sleep behavior disorder in a patient with pontine stroke. Sleep Med 2009; 10: 143-6.
  • 54 Kimura K, Tachibana N, Kohyama J. et al. A discrete pontine ischemic lesion could cause REM sleep behavior disorder. Neurology 2000; 55: 894-895.
  • 55 Tang WK, Hermann DM, Chen YK, Liang HJ, Liu XX, Chu WC, Ahuja AT, Abrigo J, Mok V, Ungvari GS, Wong KS. Brainstem infarcts predict REM sleep behavior disorder in acute ischemic stroke. BMC Neurol 2014; 14: 88.
  • 56 Iranzo A, Molinuevo JL, Santamaría J, Serradell M, Martí MJ, Valldeoriola F, Tolosa E. Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 2006; 5: 572-7.
  • 57 Nishino S, Kanbayashi T. Symptomatic narcolepsy, cataplexy, and hypersomnia, and their implications in the hypothalamic hypocretin/orexin system. Sleep Med Rev 2005; 9: 269-310.
  • 58 International Classification of Sleep Disorders. 3rd Edition American Academy of Sleep Medicine 2014. Chest 2014; 146 (05) 1387-94.