Sleep-wake disturbances in supra-and infratentorial stroke: an analysis of post-acute sleep architecture and apnea

Background and purpose: Sleep-wake disturbances (SWD) are common following stroke, and often extend into the post-acute to chronic periods of recovery. Of particular interest to recovery is a reduction in rapid eye movement (REM) sleep, as we know REM sleep to be important for learning and memory. While there is a breadth of evidence linking SWD and stroke, much less work has been done to identify and determine if differences in sleep architecture and apnea severity are dependent on stroke infarct topographies.

Methods: A retrospective chart review was conducted of 48 ischemic stroke patients having underwent a full, overnight polysomnography (PSG). All patients were over 30 days post-injury (post-acute) at the time of the PSG. Patients were divided into supra- and infratentorial infarct topography groups based on available medical and imaging records. In addition to sleep study record review, cognitive and outcome measures were examined.

Results: Results showed that patients with infratentorial stroke had poorer sleep efficiency, decreased REM sleep, and higher apnea hypopnea index (AHI) than those with supratentorial injuries. Longer continuous REM periods were correlated with higher verbal learning/memory scores, higher levels of positive affect, and lower levels of emotional/behavioral dyscontrol. Neither age nor AHI were significantly correlated with the amount or duration of REM. Slow-wave sleep was significantly reduced across both injury topographies.

Conclusions: Infratentorial ischemic stroke patients display significant disruptions in sleep architecture and may require close monitoring for SWDs in the post-acute period to maximize outcome potential. REM sleep is particularly affected when compared to supratentorial ischemic stroke.