Sleep and Cognitive Dysfunction in Subarachnoid Hemorrhage: A Scoping Review

Subarachnoid hemorrhage (SAH) is a devastating form of stroke that disproportionately affects younger individuals and often results in long-term disability, even among those who achieve favorable outcomes on traditional clinical scales. This scoping review uses the PRISMA-ScR protocol to evaluate independent studies from 1980 to 2025 and synthesizes current evidence on sleep and cognitive dysfunction in SAH survivors, highlighting their prevalence, impact, and gaps in assessment and management. A total of 2243 publications were screened across three databases (PubMed, EMBASE, and Web of Science), which resulted in 115 studies analyzed for review. Sleep disturbances-including insomnia, hypersomnia, and sleep apnea-are common across all phases of recovery and are closely linked to fatigue, mood disorders, and impaired cognitive function. Cognitive deficits, particularly in memory, executive function, and attention, persist in most survivors and are significant barriers to return to work and reintegration. Despite their clinical relevance, these domains are underrepresented in SAH research and inadequately captured by standard outcome measures such as the modified Rankin Scale. Compared to moderate-to-severe traumatic brain injury (TBI), the SAH literature lacks standardized assessment tools, longitudinal data, and interventional studies. Neuroinflammation may underlie both sleep and cognitive sequelae, offering a potential therapeutic target. This review underscores the need for patient-centered outcome measures, integrated sleep and cognitive assessments, and targeted interventions to improve long-term brain health in SAH survivors.