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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke
Open accessAbstract
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.
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“Stroke has been consistently identified as a devastating outcome of untreated severe OSA, especially in middle aged adults.120”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [120]
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Metadata
- Authors
- Bassetti, C. L. A., Randerath, W., Vignatelli, L., Ferini-Strambi, L., Brill, A.-K., Bonsignore, M. R., Grote, L., Jennum, P., Leys, D., Minnerup, J., Nobili, L., Tonia, T., Morgan, R., Kerry, J., Riha, R., McNicholas, W. T., & Papavasileiou, V.
- Affiliations
- Sechenov University (RU)
- University of Cologne (DE)
- Istituto delle Scienze Neurologiche di Bologna (IT)
- University of Bern (CH)
- National Research Council (IT)
- Sahlgrenska University Hospital (SE)
- Rigshospitalet (DK)
- Université de Lille (FR)
- University of Münster (DE)
- Istituto Giannina Gaslini (IT)
- McMaster University (CA)
- Leeds Teaching Hospitals NHS Trust (GB)
- Edinburgh Royal Infirmary (GB)
- University College Dublin (IE)
- University of Leeds (GB)
- ORCID
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2020-04
- Volume
- 55
- Issue
- 4
- Pages
- 1901104
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W3017016793
- Cited by
- 132
- References
- 161
- Citations by year
- 2026: 15 · 2025: 21 · 2024: 22 · 2023: 25 · 2022: 20 · 2021: 16 · 2020: 13
- FWCI
- 11.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Keywords
- sleep disorders, stroke, obstructive sleep apnea, continuous positive airway pressure, stroke risk, stroke recurrence, stroke mortality, insomnia, restless legs syndrome, periodic limb movements in sleep, post-stroke insomnia, stroke outcome, sleep apnea screening
- MeSH terms
- Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Prevalence, Sleep Apnea, Obstructive, Stroke, Continuous Positive Airway Pressure
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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