The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
Sleep Med Rev. 2019 Jun;45:54-69. doi: 10.1016/j.smrv.2019.03.003. Epub 2019 Mar 20.
Sleep and circadian rhythm disruption are potentially modifiable risk factors and consequences of ischaemic stroke. Pre-clinical evidence suggests a direct effect of sleep and endogenous circadian rhythm dysfunction on lesion volumes and post-stroke recovery. In humans, sleep and stroke literature has focused primarily on obstructive sleep apnoea. However, the bidirectional impact of non-apnoea related sleep disorders, sleep architecture, and endogenous circadian rhythm dysfunction in ischaemic stroke remains unclear. A systematic search of publications in three major databases from inception to August 7 2018 identified 67 studies meeting inclusion criteria. Long sleep duration or sleep disorders significantly increased the risk of ischaemic stroke. Inversely, ischaemic stroke was associated with sleep architectural and endogenous circadian rhythm disruption which were generally associated with post-stroke severity and functional outcome. Importantly, no studies examined direct measures of circadian rhythm dysfunction as a risk factor for ischaemic stroke. Most studies were moderate to high quality. However, methodology and stroke characteristics (e.g., stroke topography, stroke severity) were heterogenous thereby limiting generalisable conclusions. Furthermore, a priori neuroimaging outcomes in conjunction with sleep and circadian features were seldom assessed. The clinical pathogenic implications and methodological limitations of studies are discussed, and a research agenda for future studies is outlined.
睡眠和昼夜节律紊乱是缺血性中风潜在的可改变的风险因素和后果。临床前证据表明，睡眠和内源性昼夜节律功能障碍对病变体积和中风后恢复有直接影响。在人类中，睡眠和中风文献主要集中在阻塞性睡眠呼吸暂停上。然而，非呼吸暂停相关睡眠障碍、睡眠结构和内源性昼夜节律功能障碍对缺血性中风的双向影响仍不清楚。从 2018 年 8 月 7 日开始，在三个主要数据库中进行了系统检索，确定了符合纳入标准的 67 项研究。睡眠时间长或睡眠障碍显著增加了缺血性中风的风险。相反，缺血性中风与睡眠结构和内源性昼夜节律紊乱有关，而这些紊乱通常与中风后的严重程度和功能结果有关。重要的是，没有研究直接检测昼夜节律功能障碍作为缺血性中风的风险因素。大多数研究的质量为中等到高度。然而，方法和中风特征（例如，中风部位、中风严重程度）存在异质性，从而限制了可推广的结论。此外，很少有研究评估与睡眠和昼夜节律特征相关的预先确定的神经影像学结果。讨论了研究的临床发病机制意义和方法学局限性，并概述了未来研究的研究议程。
