Sleep-Wake Disorders in Stroke—Increased Stroke Risk and Deteriorated Recovery? An Evaluation on the Necessity for Prevention and Treatment

  • Simone B. Duss
  • Anne-Kathrin Brill
  • Panagiotis Bargiotas
  • Laura Facchin
  • Filip Alexiev
  • Mauro Manconi
  • Claudio L. BassettiEmail author
Stroke (H Diener, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stroke


Purpose of Review

Sleep-wake disorders (SWD) are common not only in the general population but also in stroke patients, in whom SWD may be pre-existent or appear “de novo” as a consequence of brain damage. Despite increasing evidence of a negative impact of SWD on cardiocerebrovascular risk, cognitive functions, and quality of life, SWD are insufficiently considered in the prevention and management of patients with stroke. This narrative review aims at summarizing the current data on the bidirectional link between SWD and stroke.

Recent Findings

Several studies have demonstrated that sleep-disordered breathing (SDB) is an independent risk factor for stroke and has a detrimental effect on stroke recovery. Short and long sleep duration and possibly other SWD (e.g., insomnia, circadian rhythm disorders) may also increase the risk of stroke and influence its outcome. Data on SDB treatment increasingly indicate a benefit on stroke risk and evolution while treatment of other SWD is still limited.


A systematic search for SWD in stroke patients is justified due to their high frequency and their negative impact on stroke outcomes. Clinicians should actively consider available treatment options.


Stroke Sleep-disordered breathing Sleepiness Insomnia Sleep duration Risk Outcome 



Apnea-hypopnea index


Adaptive servoventilation


Brain-derived neurotropic factor


Cognitive-behavioral therapy


Cognitive-behavioral therapy for insomnia


Confidence interval


Continuous positive airway pressure


Excessive daytime sleepiness


Hazard ratio


Mid-sleep on free days corrected for over-sleep on free days


Non-rapid eye movement


Odds ratio


Obstructive sleep apnea


Periodic limb movements


REM sleep behavior disorder


Randomized clinical trials


Rapid eye movement


Restless legs syndrome


Sleep-disordered breathing


Standardized mean difference


Sleep related movement disorders


Sleep-wake disorders


Transient ischemic attack


Funding Information

This work was supported by the Swiss National Science Foundation (Grant 320030_149752, Grant 33IC30_166827).

Compliance with Ethical Standards

Conflict of Interest

Simone B. Duss, Anne-Kathrin Brill, Panagiotis Bargiotas, Laura Facchin, Filip Alexiev, Mauro Manconi, and Claudio L. Bassetti declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Simone B. Duss
    • 1
    • 2
  • Anne-Kathrin Brill
    • 2
    • 3
  • Panagiotis Bargiotas
    • 1
    • 2
  • Laura Facchin
    • 4
  • Filip Alexiev
    • 1
    • 2
  • Mauro Manconi
    • 1
    • 5
  • Claudio L. Bassetti
    • 1
    • 2
    • 4
    • 6
    Email author
  1. 1.Department of NeurologyBern University Hospital (Inselspital) and University of BernBernSwitzerland
  2. 2.Interdisciplinary Sleep-Wake-Epilepsy-CenterBern University Hospital (Inselspital) and University of BernBernSwitzerland
  3. 3.Department of Pulmonary MedicineBern University Hospital (Inselspital) and University of BernBernSwitzerland
  4. 4.Center for Experimental Neurology (ZEN)Bern University Hospital (Inselspital) and University of BernBernSwitzerland
  5. 5.Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of LuganoLuganoSwitzerland
  6. 6.Department of NeurologySechenov UniversityMoscowRussian Federation

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