Sleep, Stroke

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

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A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Walter N. Kernan, MD, Bruce Ovbiagele, MD, MSc, MAS, Henry R. Black, MD, et al. Stroke. Originally published May 1, 2014.

  • Hypertension: Goals for target BP level or reduction from pretreatment baseline are uncertain and should be individualized, but it is reasonable to achieve a systolic pressure <140 mm Hg and a diastolic pressure <90 mm Hg. For patients with a recent lacunar stroke, it might be reasonable to target an SBP of <130 mmHg.
  • Dyslipidemia: Statin therapy with intensive lipid-lowering effects is recommended to reduce risk of stroke and cardiovascular events among patients with ischemic stroke or TIA presumed to be of atherosclerotic origin, an LDL-C level <100 mg/dL, and no evidence for other clinical ASCVD.
  • Diabetes mellitus: After a TIA or ischemic stroke, all patients should probably be screened for DM with testing of fasting plasma glucose, HbA1c, or an oral glucose tolerance test. Choice of test and timing should be guided by clinical judgment and recognition that acute illness may temporarily perturb measures of plasma glucose. In general, HbA1cmay be more accurate than other screening tests in the immediate postevent period.
  • Physical inactivity: For patients with ischemic stroke or TIA who are capable of engaging in physical activity, at least 3 to 4 sessions per week of moderate- to vigorous-intensity aerobic physical exercise are reasonable to reduce stroke risk factors. Sessions should last an average of 40 minutes. Moderate-intensity exercise is typically defined as sufficient to break a sweat or noticeably raise heart rate (eg, walking briskly, using an exercise bicycle). Vigorous-intensity exercise includes activities such as jogging.
  • Obstructive sleep apnea: A sleep study might be considered for patients with an ischemic stroke or TIA on the basis of the very high prevalence of sleep apnea in this population and the strength of the evidence that the treatment of sleep apnea improves outcomes in the general population. Treatment with CPAP might be considered for patients with ischemic stroke or TIA and sleep apnea given the emerging evidence in support of improved outcomes.
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