Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France.
National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France.
Rev Neurol (Paris). 2023 Oct;179(7):782-792. doi: 10.1016/j.neurol.2023.08.004. Epub 2023 Aug 21.
Sleep-wake disorders (SWD) are acknowledged risk factors for both ischemic stroke and poor cardiovascular and functional outcome after stroke. SWD are frequent following stroke, with sleep apnea (SA) being the most frequent SWD affecting more than half of stroke survivors. While sleep disturbances and SWD are frequently reported in the acute phase, they may persist in the chronic phase after an ischemic stroke. Despite the frequency and risk associated with SWD following stroke, screening for SWD remains rare in the clinical setting, due to challenges in the assessment of post-stroke SWD, uncertainty regarding the optimal timing for their diagnosis, and a lack of clear treatment guidelines (i.e., when to treat and the optimal treatment strategy). However, little evidence support the feasibility of SWD treatment even in the acute phase of stroke and its favorable effect on long-term cardiovascular and functional outcomes. Thus, sleep health recommendations and SWD treatment should be systematically embedded in secondary stroke prevention strategy. We therefore propose that the management of SWD associated with stroke should rely on a multidisciplinary approach, with an integrated diagnostic, treatment, and follow-up strategy. The challenges in the field are to improve post-stroke SWD diagnosis, prognosis and treatment, through a better appraisal of their pathophysiology and temporal evolution.
睡眠-觉醒障碍（SWD）被认为是缺血性卒中以及卒后心血管和功能预后不良的危险因素。SWD 在卒中后很常见，睡眠呼吸暂停（SA）是最常见的 SWD，影响了超过一半的卒中幸存者。尽管睡眠障碍和 SWD 在急性期经常被报道，但它们可能会在缺血性卒中后慢性期持续存在。尽管卒中后 SWD 的频率和风险很高，但由于卒中后 SWD 的评估存在挑战、对其诊断的最佳时机存在不确定性以及缺乏明确的治疗指南（即何时治疗和最佳治疗策略），SWD 的筛查在临床环境中仍然很少见。然而，几乎没有证据支持 SWD 治疗的可行性，即使在卒中的急性期，以及它对长期心血管和功能结局的有利影响。因此，睡眠健康建议和 SWD 治疗应系统地纳入二级卒中预防策略。因此，我们提出与卒中相关的 SWD 的管理应依赖于多学科方法，采用综合的诊断、治疗和随访策略。该领域的挑战是通过更好地评估其病理生理学和时间演变来改善卒中后 SWD 的诊断、预后和治疗。
