Sleep-disordered breathing and stroke.

Area of Science:

• Neurology
• Sleep Medicine
• Cardiovascular Science

Background:

• Sleep-related breathing disorders (SRBD) are linked to a higher stroke risk, independent of other factors.
• The causal direction likely favors SRBD leading to stroke, though further research is needed.
• The high prevalence of SRBD suggests significant public health implications if a causal relationship is confirmed.

Purpose of the Study:

• To explore the complex relationship between sleep-disordered breathing and stroke risk.
• To identify potential mechanisms linking SRBD to cerebrovascular events.
• To emphasize the importance of investigating SRBD in stroke patients.

Main Methods:

• Review of existing literature on SRBD and stroke.
• Analysis of proposed pathophysiological mechanisms.
• Clinical recommendations for diagnosis and management.

Main Results:

• SRBD is associated with increased stroke risk through multifactorial mechanisms.
• Mechanisms include reduced cerebral blood flow, altered cerebral autoregulation, endothelial dysfunction, atherogenesis, thrombosis, and embolism.
• Hypertension is a key mediator linking SRBD to stroke risk.

Conclusions:

• Patients with stroke or TIA should be screened for SRBD via sleep history, physical exam, and polysomnography.
• Treatment of sleep apnea can improve quality of life, blood pressure, sleep, cognition, and daytime sleepiness.
• Further trials are necessary to confirm if SRBD treatment improves stroke outcomes and serves as secondary prophylaxis.