Sleep Disorders and Recovery in Stroke Patients

Stroke outcomes are increasingly shaped by the prevalence and severity of sleep disturbances both before and after the cerebrovascular event. Sleep disorders act as independent modifiable risk factors for stroke and contribute to poorer functional and cognitive outcomes when they appear as a consequence of ischaemia. Among survivors, breathing-related sleep apnoea, insomnia, hypersomnia, periodic limb movements and disrupted circadian rhythms are commonly reported, with each disorder exerting a deleterious effect on neuroplasticity, mood, cardiovascular regulation and rehabilitation engagement. Disturbances in rapid eye movement and slow-wave sleep impair the consolidation of motor and cognitive learning, while excessive daytime sleepiness and sleep fragmentation are linked to slower gains in activities of daily living. The bidirectional relationship between sleep and stroke underlines the need for routine screening in acute and chronic care settings. Emerging evidence indicates that targeted pharmacological and behavioural therapies, alongside digital monitoring using wearable sensors, can mitigate sleep disruption and facilitate motor recovery, mood stabilisation and overall quality of life. A holistic rehabilitation approach that integrates sleep management therefore holds substantial promise for improving global stroke outcomes.

Research from Nature Portfolio

A physiological study of community-dwelling patients more than twelve months after a first stroke employed both overnight polysomnography and the Multiple Sleep Latency Test to characterise post-stroke insomnia and daytime sleepiness. Compared with age-matched controls, stroke survivors exhibited longer sleep latencies, lower sleep efficiency and more high-frequency EEG activity during non-rapid eye movement sleep. Despite greater wake efficiency in daytime nap testing, participants reported persistent nocturnal awakenings and non-restorative sleep. These findings emphasise that chronic post-stroke insomnia is under-recognised within rehabilitation pathways and that addressing sleep continuity through tailored interventions may enhance long-term functional recovery and quality of life.

Sleep Disorders and Recovery in Stroke Patients publication trend

The graph below shows the total number of articles in sleep disorders and recovery in stroke patients across all publications each year (not limited to Nature Index journals).

Technical terms

Insomnia: difficulty initiating or maintaining sleep, often leading to non-restorative rest and daytime impairment.

Sleep efficiency: proportion of time spent asleep relative to time spent in bed, expressed as a percentage.

Circadian rhythm: intrinsic 24-hour cycle regulating sleep–wake timing, hormone release and body temperature.

Polysomnography: comprehensive overnight recording of brain waves, muscle activity and respiration to assess sleep architecture.

Actigraphy: wrist-worn sensors that detect movement patterns to estimate sleep and wake periods over prolonged intervals.

Multiple Sleep Latency Test: objective measure of daytime sleepiness by recording time to sleep onset across successive nap opportunities.

Suprachiasmatic nucleus: hypothalamic structure acting as the central pacemaker for circadian rhythms.

References

1. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. International Journal of Stroke (2023).
2. Rest-Activity Rhythm Differences in Acute Rehabilitation Between Poststroke Patients and Non–Brain Disease Controls: Comparative Study. Journal of Medical Internet Research (2024).
3. Alleviating sleep disturbances and modulating neuronal activity after ischemia: Evidence for the benefits of zolpidem in stroke recovery. CNS Neuroscience & Therapeutics (2024).
4. Post-stroke insomnia in community-dwelling patients with chronic motor stroke: Physiological evidence and implications for stroke care. Scientific Reports (2018).
5. Is Sleep Essential for Neural Plasticity in Humans, and How Does It Affect Motor and Cognitive Recovery?. Neural Plasticity (2013).
6. Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery. Neurorehabilitation and Neural Repair (2020).