Sleep And Circadian Rhythm Dysfunction In Human Ischemic Stroke : A Systematic Review
Bibliographic record
Abstract
Background and Aims:Sleep and circadian rhythm pathologies are potentially modifiable risk factors and consequences of ischemic stroke (IS). Experimental sleep and endogenous circadian-rhythm disruption activate deleterious pathophysiological mechanisms which contribute to the pathogenesis and evolution of IS. Sleep and stroke research in humans has primarily focused on obstructive sleep apnea. We conducted a systematic review to assess the bidirectional relationship of non-apnea sleep disorders, sleep architecture, and endogenous circadian-rhythm dysfunction in patients with IS.Methods:Systematic searches in MEDLINE, Embase, and PsycINFO were conducted in accordance with PRISMA guidelines. Extracted variables were chosen based on the STROBE guidelines and appraisal of methodological quality was assessed using the Newcastle-Ottawa scale.Results:A systematic search yielded 5192 unique citations, of which 67 observational studies met inclusion criteria. Study quality was generally moderate (n=39) to high (n=27). Thirty-one studies included relevant neuroimaging outcomes. Long-sleep duration (u22658 hours) and non-apnea sleep disorders significantly increase the risk of IS after adjusting for cerebrovascular covariates. Inversely, IS was associated with suppressed sleep architecture and endogenous circadian-rhythms relative to controls which was associated with worse post-stroke severity and recovery.Conclusions:Prolonged sleep duration and non-apnea sleep disorders increase the risk of IS, while sleep architecture and endogenous circadian-rhythms are disrupted after IS and associated with worse post-stroke outcome. However, study methodology (e.g., stroke to sleep and circadian assessment times) and stroke topography were heterogenous thereby limiting generalizable conclusions. Homogenous neuroimaging-driven prospective studies are warranted to elucidate the bidirectionally neuroprotective role of normalized sleep and circadian-rhythms in IS.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".