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Study objectives: Sleep and circadian rhythms disorders are frequent in the acute stroke. Sleep modifications are likely to contribute to the development of stroke-related delirium, a common neuropsychiatric complication of acute stroke. This systematic review aimed to clarify the association between sleep modifications and the occurrence of delirium in patients with acute stroke. Methods: The current systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was performed on PubMed and Scopus databases. Only studies that provided data concerning sleep, or pre-existing sleep disorders, in acute stroke and performed a formal evaluation of delirium were included. Results: The literature search enabled the identification of 15 studies, which exhibited high heterogeneity in terms of study design, settings, sleep assessments, delirium measures, and types of sleep intervention. In the study quality assessment, the majority of the studies were rated as weak or moderate. In most of the cases, sleep was subjectively assessed by the patients or rated by clinicians. None of the studies performed polysomnography for the evaluation of sleep. Only four of the studies assessed the impact of a sleep intervention on delirium, suggesting the potentially protective role of sleep promotion in reducing the prevalence and severity of stroke-related delirium. Conclusions: The evidence arising from the present systematic review supports that sleep disruption is a potential promoting factor for stroke-related delirium. We suggest that a formal sleep assessment and sleep promotion should be included in routine stroke care. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke. [ABSTRACT FROM AUTHOR]

Introduction: Autonomic dysfunction has been reported as one of nonmotor manifestations of both presymptomatic and manifest Huntington's disease (HD). The aim of our study was to evaluate heart rate variability (HRV) during wake and sleep in a cohort of patients with manifest HD. Methods: Thirty consecutive patients with manifest HD were enrolled, 14 men and 16 women, mean age 57.3 ± 12.2 years. All patients underwent full-night attended video polysomnography. HRV was analyzed during wake, NREM sleep, and REM sleep, in time and frequency domain. Results were compared with a control group of healthy volunteers matched for age and sex. Results: During wake, HD patients presented significantly higher mean heart rate than controls (72.4 ± 9.6 vs. 58.1 ± 7.3 bpm; p < 0.001). During NREM sleep, HD patients showed higher mean heart rate (65.6 ± 11.1 vs. 48.8 ± 4.6 bpm; p < 0.001) and greater low frequency (LF) component of HRV (52.9 ± 22.6 vs. 35.5 ± 17.3 n.u.; p = 0.004). During REM sleep, we observed lower standard deviation of the RR interval in HD subjects (3.4 ± 2.2 vs. 3.7 ± 1.3 ms; p = 0.015). Conclusion: Our results show that HD patients have higher heart rate than controls, during wake and NREM, but not during REM sleep. Among HRV parameters, the most relevant difference regarded the LF component, which reflects, at least partially, the ortho-sympathetic output. Our results confirm the involvement of autonomic nervous system in HD and demonstrate that it is evident during both wake and sleep. [ABSTRACT FROM AUTHOR]