EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

C L A Bassetti; W Randerath; L Vignatelli; L Ferini-Strambi; A-K Brill; M R Bonsignore; L Grote; P Jennum; D Leys; J Minnerup; L Nobili; T Tonia; R Morgan; J Kerry; R Riha; W T McNicholas; V Papavasileiou

doi:10.1111/ene.14201

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Eur J Neurol. 2020 Jul;27(7):1117-1136. doi: 10.1111/ene.14201. Epub 2020 Apr 20.

Authors

C L A Bassetti^{1

2}, W Randerath³, L Vignatelli⁴, L Ferini-Strambi⁵, A-K Brill⁶, M R Bonsignore⁷, L Grote⁸, P Jennum⁹, D Leys¹⁰, J Minnerup¹¹, L Nobili¹², T Tonia¹³, R Morgan¹⁴, J Kerry¹⁵, R Riha^{16

17}, W T McNicholas^{18

19

20}, V Papavasileiou^{21

22}

Affiliations

¹ Neurology Department, Medical Faculty, University Hospital, Bern, Switzerland.
² Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia.
³ Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany.
⁴ Servizio di Epidemiologia e Biostatistica IRCCS, Istituto delle Scienze Neurologiche di Bologna Ospedale Bellaria, Bologna, Italy.
⁵ Department of Neurology OSR-Turro, Sleep Disorder Center, Vita-Salute San Raffaele University, Milan, Italy.
⁶ Department of Pulmonary Medicine, University and University Hospital Bern, Bern, Switzerland.
⁷ PROMISE Department, Division of Respiratory Medicine, DiBiMIS, University of Palermo and IBIM-CNR, Palermo, Italy.
⁸ Sleep Disorders Center, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
⁹ Danish Center for Sleep Medicine, Rigshospitalet, Copenhagen, Denmark.
¹⁰ Department of Neurology, University of Lille, Lille, France.
¹¹ Department of Neurology and Institute for Translational Neurology, University of Muenster, Muenster, Germany.
¹² Child Neuropsychiatry Unit, Gaslini Institute DINOGMI, University of Genova, Genoa, Italy.
¹³ Institute of Social and Preventive Medicine, Universtity of Bern, Bern, Switzerland.
¹⁴ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
¹⁵ Library and Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁶ Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
¹⁷ Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹⁸ Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland.
¹⁹ School of Medicine, University College Dublin, Dublin, Ireland.
²⁰ First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
²¹ Leeds Teaching Hospital NHS Trust, Leeds, UK.
²² Medical School, University of Leeds, Leeds, UK.

PMID: 32314498
DOI: 10.1111/ene.14201

Abstract

Background: Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.

Aim: Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology to critically evaluate the evidence regarding potential links and the impact of therapy.

Materials and methods: Thirteen research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies post-dating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 were included. Statements were generated regarding current evidence and clinical practice.

Results: Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, whilst CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, whilst the pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, whilst treatment data are scarce.

Discussion/conclusion: Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke.

Keywords: PLMS; insomnia; outcome; restless legs; risk; sleep disordered breathing; sleep disorders; stroke.

MeSH terms

Continuous Positive Airway Pressure
Humans
Middle Aged
Prevalence
Restless Legs Syndrome*
Sleep Apnea, Obstructive*
Stroke* / complications
Stroke* / epidemiology
Stroke* / therapy