Sooner Than Later If Not Right After Stroke

Abstract

The case involves a patient with interrelated sleep symptoms related to central hypersomnia, restless legs syndrome, and sleep disordered breathing (SDB) occurring after stroke. The prevalence of SDB after stroke has been noted to be very high, up to 70%, and consists of a higher contribution of central sleep apnea compared to the general population. Recurrent stroke is associated with a higher prevalence of SDB compared to first-time stroke. Contributions to SDB as related to stroke do not appear to have consistencies in terms of location and size of stroke. Untreated SDB can also contribute to stroke risk, with mechanisms involving increased systemic inflammation, prothrombotic biochemical markers, and dysfunction of cerebral autoregulation. Although there are post-hoc subgroup data in a randomized controlled trial suggesting reduction in stroke outcomes when SDB is treated with positive airway pressure, overall there are few studies that have rigorously examined the impact of treatment. Hypersomnia can be treated with modafinil and restless legs syndrome may become manifest due to sleep fragmentation.