title: Polysomnographic Characteristics of Sleep in Stroke: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Research on sleep after stroke has focused mainly on sleep disordered breathing. However, the extend to which sleep physiology is altered in stroke survivors, how these alterations compare to healthy volunteers, and how sleep changes might affect recovery as well as physical and mental health has yet to be fully researched. Motivated by the view that a deeper understanding of sleep in stroke is needed to account for its role in health and well-being as well as its relevance for recovery and rehabilitation, we conducted a systematic review and meta-analysis of polysomnographic studies comparing stroke to control populations.
  
  
  METHODS
  Medline and PsycInfo databases were searched using "stroke" and words capturing polysomnographic parameters as search terms. This yielded 1692 abstracts for screening, with 15 meeting the criteria for systematic review and 9 for meta-analysis. Prisma best practice guidelines were followed for the systematic review; the Comprehensive Meta-Analysis software was used for random effects modelling.
  
  
  RESULTS
  The meta-analysis revealed that patients with stroke have poorer sleep than controls. Patients had lower sleep efficiency (mean 75% vs 84%), shorter total-sleep-time (309.4 vs 340.3 min) and more wake-after-sleep-onset (97.2 vs 53.8 min). Patients also spend more time in stage 1 (13% vs 10%) and less time in stage 2 sleep (36% vs 45%) and slow-wave-sleep (10% vs 12%). No group differences were identified for REM sleep. The systematic review revealed a strong bias towards studies in the early recovery phase of stroke, with no study reporting specifically on patients in the chronic state. Moreover, participants in the control groups included community samples as well as other patients groups.
  
  
  CONCLUSIONS
  These results indicate poorer sleep in patients with stroke than controls. While strongly suggestive in nature, the evidence base is limited and methodologically diverse, and hands a clear mandate for further research. A particular need regards polysomnographic studies in chronic community-dwelling patients compared to age-matched individuals.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Chiara
authors.initials: C
authors.lastname: Baglioni
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nissen
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Schweinoch
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Riemann
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Spiegelhalder
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Weiller
authors.affiliation: School of Psychology, University of Surrey, Surrey, United Kingdom.|Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Annette
authors.initials: A
authors.lastname: Sterr
mesh_terms: D006801:Humans; D017286:Polysomnography / Q000379:methods*; D012890:Sleep; D020521:Stroke / Q000503:physiopathology*