Mechanism of Insomnia After Stroke Based on Intestinal Flora

Stroke has emerged as the second leading cause of mortality. Insomnia after stroke is a highly prevalent complication of stroke with a complex mechanism, impacting daily activities and hindering neurological function rehabilitation while also increasing the risk of stroke recurrence. With the development of molecular biology, intestinal flora has garnered considerable interest in the past few years because of its significant implications for human physiology and pathology. Numerous studies have emphasized the crucial function of intestinal flora in the pathological changes associated with insomnia after stroke. It can influence sleep patterns following a stroke by modulating various pathways, including the hypothalamic-pituitary-adrenal (HPA) axis, immune responses, and neural mechanisms. Disruption of intestinal flora can adversely affect post-stroke sleep quality, while sleep after stroke can also lead to intestinal flora imbalance. Based on the intestinal flora, this paper explores the involvement of hypothalamic-pituitary-adrenal axis (HPA axis), immune pathway and neural pathway in insomnia after stroke, aiming to offer insights for the prevention, treatment, and research of post-stroke insomnia.