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Review

Sleep Disorders and Stroke: Pathophysiological Links, Clinical Implications, and Management Strategies

1
Neurology Department, Cooper University Hospital, Camden, NJ 08103, USA
2
Faculty of Medicine, Alexandria University, Alexandria 5372066, Egypt
3
School of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
4
Faculty of Medicine, Assiut University, Assiut 71515, Egypt
*
Author to whom correspondence should be addressed.
Med. Sci. 2025, 13(3), 113; https://doi.org/10.3390/medsci13030113
Submission received: 3 June 2025 / Revised: 13 July 2025 / Accepted: 1 August 2025 / Published: 5 August 2025

Abstract

Sleep disorders and stroke are intricately linked through a complex, bidirectional relationship. Sleep disturbances such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) not only increase the risk of stroke but also frequently emerge as consequences of cerebrovascular events. OSA, in particular, is associated with a two- to three-fold increased risk of incident stroke, primarily through mechanisms involving intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation. Conversely, stroke can disrupt sleep architecture and trigger or exacerbate sleep disorders, including insomnia, hypersomnia, circadian rhythm disturbances, and breathing-related sleep disorders. These post-stroke sleep disturbances are common and significantly impair rehabilitation, cognitive recovery, and quality of life, yet they remain underdiagnosed and undertreated. Early identification and management of sleep disorders in stroke patients are essential to optimize recovery and reduce the risk of recurrence. Therapeutic strategies include lifestyle modifications, pharmacological treatments, medical devices such as continuous positive airway pressure (CPAP), and emerging alternatives for CPAP-intolerant individuals. Despite growing awareness, significant knowledge gaps persist, particularly regarding non-OSA sleep disorders and their impact on stroke outcomes. Improved diagnostic tools, broader screening protocols, and greater integration of sleep assessments into stroke care are urgently needed. This narrative review synthesizes current evidence on the interplay between sleep and stroke, emphasizing the importance of personalized, multidisciplinary approaches to diagnosis and treatment. Advancing research in this field holds promise for reducing the global burden of stroke and improving long-term outcomes through targeted sleep interventions.
Keywords: sleep disorder; insomnia; obstructive sleep apnea; sleep-disorder breathing; cardiovascular risk; cerebrovascular risk; stroke sleep disorder; insomnia; obstructive sleep apnea; sleep-disorder breathing; cardiovascular risk; cerebrovascular risk; stroke

Share and Cite

MDPI and ACS Style

Rissardo, J.P.; Khalil, I.; Taha, M.; Chen, J.; Sayad, R.; Fornari Caprara, A.L. Sleep Disorders and Stroke: Pathophysiological Links, Clinical Implications, and Management Strategies. Med. Sci. 2025, 13, 113. https://doi.org/10.3390/medsci13030113

AMA Style

Rissardo JP, Khalil I, Taha M, Chen J, Sayad R, Fornari Caprara AL. Sleep Disorders and Stroke: Pathophysiological Links, Clinical Implications, and Management Strategies. Medical Sciences. 2025; 13(3):113. https://doi.org/10.3390/medsci13030113

Chicago/Turabian Style

Rissardo, Jamir Pitton, Ibrahim Khalil, Mohamad Taha, Justin Chen, Reem Sayad, and Ana Letícia Fornari Caprara. 2025. "Sleep Disorders and Stroke: Pathophysiological Links, Clinical Implications, and Management Strategies" Medical Sciences 13, no. 3: 113. https://doi.org/10.3390/medsci13030113

APA Style

Rissardo, J. P., Khalil, I., Taha, M., Chen, J., Sayad, R., & Fornari Caprara, A. L. (2025). Sleep Disorders and Stroke: Pathophysiological Links, Clinical Implications, and Management Strategies. Medical Sciences, 13(3), 113. https://doi.org/10.3390/medsci13030113

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