Prestroke sleep and stroke: a narrative review.

Objectives: This review aims to explore the relationship between poor pre-stroke sleep and stroke.

Results: Pre-stroke sleep duration is associated with the risk and mortality of total stroke, exhibiting a 'U-shaped' or 'J-shaped' dose-response relationship. Regarding stroke subtypes, prolonged sleep duration is linked to an increased risk of ischemic stroke, while short sleep duration is associated with hemorrhagic and wake-up strokes. Additionally, poor sleep quality is one of the risk factors for stroke occurrence. Moreover, daytime napping can mitigate the negative consequences of sleep issues, but attention should be paid to the duration and frequency of naps. Finally, disruptions in circadian rhythms, inflammatory responses, endocrine changes, and alterations in the autonomic nervous system may be potential pathogenic mechanisms through which chronic poor sleep leads to stroke.

Conclusions: Healthy individuals experiencing poor sleep can be considered susceptible to stroke. It is crucial to further refine stroke risk assessments for these individuals and provide targeted medical advice. Additionally, we should identify the optimal duration and frequency of naps to reduce the risk of stroke. Furthermore, closer attention should be paid to the temporal dimension to address the challenges that modern societal changes pose to circadian rhythms. Lastly, the relationship between chronic poor sleep and sleep disorders should also be closely examined.