Multiple sleep-wake disturbances after stroke predict an increased risk of cardio-cerebrovascular events or death - a prospective cohort study.

Duss, Simone B; Bernasconi, Corrado; Steck, Anita; Brill, Anne-Kathrin; Manconi, Mauro; Dekkers, Martijn; Schmidt, Markus H; Bassetti, Claudio L. A. (2023). Multiple sleep-wake disturbances after stroke predict an increased risk of cardio-cerebrovascular events or death - a prospective cohort study. European journal of neurology, 30(6), pp. 1696-1705. Wiley 10.1111/ene.15784

[img] Text
Euro_J_of_Neurology_-_2023_-_Duss_-_Multiple_sleep_wake_disturbances_after_stroke_predict_an_increased_risk_of.pdf - Accepted Version
Restricted to registered users only until 13 March 2024.
Available under License Publisher holds Copyright.

Download (923kB) | Request a copy


In the general population, sleep-wake disturbances (SWD) have been shown to increase the risk of cardio- and cerebrovascular events (CCE) including death. Systematic studies on the effect of SWD on the risk of CCE in patients with stroke are lacking.


Patients with acute ischemic stroke or transient ischemic attack (TIA) were prospectively recruited. Four SWD were analyzed: 1) sleep-disordered breathing (SDB) with respirography, 2) insomnia (by insomnia severity index, ISI), 3) restless legs syndrome (RLS, by International RLS Study Group rating scale) and 4) self-estimated sleep duration at 1 and 3 months. A "sleep burden index" as the mean of z-transformed values from assessments of these four SWD was created. The occurrence of CCE was recorded over a follow-up of 3.2±0.3 years (mean±standard deviation).


We assessed 437 patients (87% ischemic stroke, 13% TIA, 64% males) with a mean age of 65.1±13.0 years. SDB (respiratory event index, REI≥5) was present in 66.2% thereof. Insomnia (ISI≥10), RLS and extreme sleep duration affected 26.2%, 6.4% and 13.7% of the patients 3-month post-stroke. Seventy out of the 437 (16%) had at least one CCE during the follow-up. The sleep burden index was associated with a higher risk for subsequent CCE including death (Odds Ratio = 1.80 per index unit, 95% CI: 1.19-2.72, p=0.0056).


The presence of multiple SWDs constitutes a risk for subsequent CCE (including death) within the first three years following stroke. Larger systematic studies should assess the sleep burden index' utility for patients' risk stratification in clinical practice.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology

UniBE Contributor:

Duss, Simone, Bernasconi, Corrado Angelo, Steck, Anita, Brill, Anne-Kathrin, Manconi, Mauro, Dekkers, Martijn, Schmidt, Markus Helmut, Bassetti, Claudio L.A.


600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

14 Mar 2023 09:22

Last Modified:

07 May 2023 00:16

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Sleep cerebro-cardiovascular events ischemic stroke outcome transient ischemic attack




Actions (login required)

Edit item Edit item
Provide Feedback