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Sleep-wake disturbances (SWD) are frequently (20%-50%) encountered in stroke patients. Clinical symptoms include hypersomnia, excessive daytime sleepiness, fatigue, and insomnia. The most dramatic forms of poststroke hypersomnia are observed in patients with bithalamic paramedian stroke. The presence of SWD after stroke is associated with cognitive and psychiatric (depression, anxiety) disturbances. The recognition and diagnosis of poststroke SWD occur primarily on clinical grounds. Validated questionnaires such as the Epworth Sleepiness Scale and the Fatigue Severity Scale may help in the recognition of poststroke sleepiness and fatigue. In patients with paramedian thalamic stroke, treatment with 20-40 mg of bromocriptine may improve apathy and presleep behavior. Changes in sleep architecture depend upon: patient and health characteristics present before the stroke, topography and extent of the lesion, associated complications of stroke (e.g. SDB, fever, infections, cardiovascular disturbances, depression, anxiety), drug treatment, and time after stroke onset.
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