Table 3.

Recommendations on diagnosis and treatment of sleep disorders and stroke (levels of evidence)

Recommendation	Level of evidence
OSA
Consider OSA treatment in men with any degree of OSA or in women with AHI > 25/h as a potential strategy for primary stroke prevention	B
Every stroke patient should be risk-stratified for OSA	A
Acute stroke patients at high risk for OSA should have overnight PSG >two-weeks after event	B
Positional therapy may be an alternative treatment for acute stroke patients with suspected or confirmed OSA	B
Stroke patients with moderate to severe OSA should be encouraged to use CPAP on a daily basis as a potential secondary stroke prevention strategy	B
Insomnia
Short-term hypnotic medications and cognitive behavioral therapy are first-line treatments for patients chronic insomnia complaints (but trials in stroke populations are lacking)	C
Circadian disorders
Consider hypertensive chronotherapy in patients with aberrant BP dipping pattern to decrease future cardiovascular and stroke risk	B
RLS/PLMs
Patients with strokes involving the basal ganglia, corona radiate, or pyramidal tract should be clinically screened for RLS	B
Poststroke RLS complaints (>two times/week) with or without PLMs resulting in insomnia, disrupted sleep, and daytime consequences should be treated to enhance stroke recovery	C

A, present and strong; AHI, apnea–hypopnea index; B, present but inconclusive or inconsistent; BP, blood pressure; C, lacking; CPAP, continuous positive airway pressure; OSA, obstructive sleep apnea; PLM, periodic limb movement; PSG, polysomnography; RLS, restless legs syndrome.