Article type: Narrative Review
Article title: Sleep Disorders and Stroke: Pathophysiological Links, Clinical Implications, and Management Strategies
Journal: Medical Sciences
Year: 2025
Authors: Jamir Pitton Rissardo, Ibrahim Khalil, Mohamad Taha, Justin Chen, Reem Sayad, and Ana LetÃcia Fornari Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
Sleep disorders and stroke are intricately linked through a complex, bidirectional relationship. Sleep disturbances such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) not only increase the risk of stroke but also frequently emerge as consequences of cerebrovascular events. OSA, in particular, is associated with a two- to three-fold increased risk of incident stroke, primarily through mechanisms involving intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation. Conversely, stroke can disrupt sleep architecture and trigger or exacerbate sleep disorders, including insomnia, hypersomnia, circadian rhythm disturbances, and breathing-related sleep disorders. These post-stroke sleep disturbances are common and significantly impair rehabilitation, cognitive recovery, and quality of life, yet they remain underdiagnosed and undertreated. Early identification and management of sleep disorders in stroke patients are essential to optimize recovery and reduce the risk of recurrence. Therapeutic strategies include lifestyle modifications, pharmacological treatments, medical devices such as continuous positive airway pressure (CPAP), and emerging alternatives for CPAP-intolerant individuals. Despite growing awareness, significant knowledge gaps persist, particularly regarding non-OSA sleep disorders and their impact on stroke outcomes. Improved diagnostic tools, broader screening protocols, and greater integration of sleep assessments into stroke care are urgently needed. This narrative review synthesizes current evidence on the interplay between sleep and stroke, emphasizing the importance of personalized, multidisciplinary approaches to diagnosis and treatment. Advancing research in this field holds promise for reducing the global burden of stroke and improving long-term outcomes through targeted sleep interventions.
Keywords: sleep disorder; insomnia; obstructive sleep apnea; sleep-disorder breathing; cardiovascular risk; cerebrovascular risk; stroke.
Full text available at:
DOI
Citation
Rissardo JP, Khalil I, Taha M, Chen J, Sayad R, Fornari Caprara AL. Sleep Disorders and Stroke: Pathophysiological Links, Clinical Implications, and Management Strategies. Medical Sciences. 2025; 13(3):113. https://doi.org/10.3390/medsci13030113
Section S1. Methodology.
Figure S1. The diagram illustrates the significant influence that post-stroke sleep disorders have on the recovery process of stroke patients.
Figure S2. Pathophysiology of sleep disorders and stroke.
Table S1. Prevalence of sleep disorders and their associated stroke risk.
Table S2. The relationship between OSA and stroke.
Table S3. The relationship between insomnia and stroke.
Table S4. The relationship between restless legs syndrome and stroke.
Table S5. Sleep disorders incidence and post-stroke risk.
Table S6. Sleep-related breathing disorders after stroke.
Table S7. Sleep-related movement disorders after stroke.
Table S8. Management of sleep disorders associated with stroke.