Objective:

Evaluate the prevalence of stroke in insomniacs and differences in sleep evaluation in insomniacs with stroke.

Background:

Sleep is essential for neuronal, metabolic and vascular health. Insomnia increases stroke risk through the development of hypertension, diabetes mellitus, and hyperlipidemia. Stroke causes insomnia by altering sleep architecture. Insomniacs have a 54% stroke risk with a prevalence of 2.71% over 4 years. About 50% of stroke patients have insomnia and only 6-7% undergo appropriate evaluation.

Design/Methods:

Performing retrospective chart review over the last 6 years, we identified 7000 insomniacs aged 18 to 89 years. Based on the reported prevalence of stroke in insomniacs, 651 patient charts were randomly selected for detailed review.

Results:

Prevalence of any stroke was 9.98%, 95% CI [7.7%-12.4%]. Ischemic stroke and TIA were the most common stroke type (92%). Pre-stroke insomnia was present in 55% of patients. Insomniacs with stroke were older (69 (56,80) vs 59 (42,69), p<0.001). Prevalence of any stroke in insomniacs seen in sleep clinic was higher (13%, 95% CI [9.6%-17.0%]) vs 6.3%, 95% CI [3.5%,8.9%], p=0.013). Sleep studies were done in 76% insomniacs seen in a sleep clinic compared to 0.3% seen by a primary care provider. About 70% of insomniacs with stroke were evaluated by sleep specialist and 52% underwent a sleep study. About 13% of insomniacs with any stroke had one additional sleep disorder. The odds of having any stroke did not significantly increase by having an additional sleep disorder (OR 1.71, 95% CI [0.95, 3.08]).

Conclusions:

Prevalence of stroke is higher in insomniacs at tertiary centers. Insomnia often precedes stroke. Insomniacs with any stroke at tertiary centers are likely to be evaluated by sleep specialists and undergo a sleep study. While more insomniacs with a stroke underwent appropriate evaluation, utilization of sleep study amongst primary care providers is less, even at tertiary centers.