Sleep apnoea and ischaemic stroke: current knowledge and future directions

Area of Science:

• Neurology
• Sleep Medicine
• Cardiovascular Disease

Background:

• Sleep apnoea is a prevalent chronic condition and a significant risk factor for ischemic stroke, stroke recurrence, and impaired functional recovery.
• Over half of stroke survivors experience sleep apnoea during the acute phase, predominantly obstructive sleep apnoea (OSA).
• While sleep apnoea may decrease in severity post-stroke, moderate to severe cases persist in up to one-third of patients during the chronic phase.

Purpose of the Study:

• To highlight the underdiagnosis and undertreatment of sleep apnoea in stroke survivors.
• To emphasize the need for improved detection, prediction, and clear treatment guidelines for post-stroke sleep apnoea.
• To address knowledge gaps regarding the pathophysiology, subtype prevalence, and temporal evolution of sleep apnoea following stroke.

Main Methods:

• Review of existing evidence on sleep apnoea diagnosis and treatment in the context of stroke.
• Analysis of the challenges in managing post-stroke sleep apnoea.
• Discussion of the need for a multidisciplinary approach.

Main Results:

• Evidence suggests sleep apnoea treatment during acute stroke is feasible and may improve recovery and long-term outcomes.
• Significant challenges remain in diagnosing and predicting sleep apnoea post-stroke.
• Uncertainty persists regarding optimal timing and strategies for sleep apnoea treatment.

Conclusions:

• Sleep apnoea is a critical, often overlooked, factor in stroke recovery.
• A comprehensive, multidisciplinary strategy is essential for the diagnosis, treatment, and follow-up of sleep apnoea in stroke patients.
• Further research is needed to clarify the pathophysiology and optimal management of sleep apnoea subtypes after stroke.