Bassetti Claudio L A, Randerath Winfried, Vignatelli Luca, Ferini-Strambi Luigi, Brill Anne-Kathrin, Bonsignore Maria R, Grote Ludger, Jennum Poul, Leys Didier, Minnerup Jens, Nobili Lino, Tonia Thomy, Morgan Rebecca, Kerry Joel, Riha Renata, McNicholas Walter T, Papavasileiou Vasileios
Neurology Dept, Medical Faculty, University Hospital, Bern, Switzerland.
Dept of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia.
Eur Respir J. 2020 Apr 21;55(4). doi: 10.1183/13993003.01104-2019. Print 2020 Apr.
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.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. 13 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 included. Statements were generated regarding current evidence and clinical practice.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, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while 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, while treatment data are scarce.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.
睡眠障碍在普通人群中极为普遍，并且可能与中风以双向方式相关联，中风是发病和死亡的主要原因之一。四个主要科学学会成立了一个由神经病学、中风、呼吸医学、睡眠医学和方法学专家组成的特别工作组，以严格评估有关潜在关联和治疗影响的证据。使用逐步分层方法对13个研究问题进行了系统的文献检索：首先是系统评价和荟萃分析；其次是系统评价/荟萃分析之后的原始研究。总共评估了445项研究，其中88项被纳入。针对当前证据和临床实践形成了声明。严重阻塞性睡眠呼吸暂停（OSA）使中风发病风险加倍，尤其是在年轻至中年患者中。持续气道正压通气（CPAP）可能会降低中风风险，尤其是在依从治疗的患者中。中风患者中OSA的患病率很高，可以通过多导睡眠图进行评估。严重OSA是中风复发的危险因素，可能与中风死亡率相关，而CPAP可能会改善中风预后。目前尚不清楚失眠是否会增加中风风险，而失眠的药物治疗可能会增加中风风险。睡眠周期性肢体运动（PLMS）而非不安腿综合征（RLS）可能与中风风险增加有关。初步数据表明中风后失眠和RLS的发生率很高，并且它们与较差的中风预后相关，而治疗数据却很少。总体而言，关于OSA与中风关系的证据基础最为充分，并支持积极的诊断和治疗。在失眠以及RLS/PLMS与中风的关系方面仍存在研究空白。
