EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke.

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.

Informations de copyright

The article has been co‐published with permission in the European Respiratory Journal and the European Journal of Neurology. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. Copyright ©European Academy of Neurology and European Respiratory Society 2020.

Déclaration de conflit d'intérêts

Conflict of interest: C.L.A. Bassetti has nothing to disclose related to this work. Conflict of interest: W. Randerath reports grants and personal fees for lectures from Weinmann, Philips Respironics, Resmed, Inspire, Heinen and Löwenstein and Genzyme, outside the submitted work. Conflict of interest: L. Vignatelli has nothing to disclose. Conflict of interest: L. Ferini-Strambi reports personal fees for advisory board work from UCB-Pharma, Italfarmaco, Resmed, Pfizer and Vitalaire Italia, outside the submitted work. Conflict of interest: A-K. Brill has nothing to disclose. Conflict of interest: M.R. Bonsignore has nothing to disclose. Conflict of interest: L. Grote reports grants and personal fees for lectures from Resmed and Itamar, personal fees for lectures from Philips, during the conduct of the study; personal fees for lectures from AstraZeneca, outside the submitted work; in addition, L. Grote has a patent for pharmacological treatment of sleep apnoea licensed to Desitin. Conflict of interest: P. Jennum has nothing to disclose. Conflict of interest: D. Leys reports compensation paid to hospital research funds and Adrinord for trials, advisory boards and symposia, from BMS/Pfizer, Boehringer Ingelheim and Bayer, outside the submitted work; and is vice editor of the European Stroke Journal. Conflict of interest: J. Minnerup has nothing to disclose. Conflict of interest: L. Nobili has nothing to disclose. Conflict of interest: T. Tonia acts as ERS methodologist. Conflict of interest: R. Morgan has nothing to disclose. Conflict of interest: J. Kerry has nothing to disclose. Conflict of interest: R. Riha has nothing to disclose. Conflict of interest: W.T. McNicholas has nothing to disclose. Conflict of interest: V. Papavasileiou has nothing to disclose.