The Potential Role of Sleep in Post-stroke Motor Learning
Authors: Brearley Duncan James 
Published: October 2023

Stroke is the primary contributor to the commencement of adult disability in the United Kingdom, and individuals who survive a stroke frequently encounter challenges in reacquiring motor abilities, which has a substantial influence on their overall well-being. Sleep disturbance is a prevalent issue affecting approximately 50% of those who have experienced a stroke. The established literature demonstrates the advantageous impacts of sleep on motor learning in individuals without health complications. However, the precise contribution of sleep to motor learning in individuals recovering from stroke remains inadequately comprehended. The objective of this review was to analyze and consolidate the available research pertaining to motor learning after stroke, with the intention of ascertaining the presence and mechanisms of this association. Sleep-induced motor learning has two distinct phases, namely sleep preceding learning (SBL) and sleep after learning (SAL). These stages facilitate the consolidation of memory and reinforce the connections between different regions of the cerebral cortex, thereby decreasing the need for the medial temporal lobe (MTL) to bind information. There is a limited yet promising body of evidence suggesting that sleep has a role in modulating motor learning and rehabilitation outcomes following a stroke. There is evidence suggesting that sleep has a positive impact on motor learning following a stroke. Several studies have shown that stroke patients exhibit increased tracking accuracy after a night of sleep compared to those who do not sleep. Sleep disruptions have an adverse effect on the functional recovery of those who have experienced a stroke, with a special emphasis on those who have suffered from moderate strokes. There exists a correlation between suboptimal sleep patterns and impaired motor recovery following a stroke, however the use of sedative medications does not yield substantial enhancements in sleep quality or rehabilitation outcomes. Moreover, the utilization of sedatives may potentially have adverse effects on memory function and neural connectivity. Although the current research shows promise, it is important to acknowledge its limitations, which include the use of subjective sleep assessments and cross-sectional study designs. In order to demonstrate a more conclusive relationship between sleep and post-stroke motor recovery, future research endeavors should incorporate objective sleep assessment techniques, longitudinal methodologies, and randomized crossover designs. In summary, the current body of research suggests a potentially beneficial impact of sleep on motor learning following a stroke. However, it is important to exercise caution when interpreting these findings due to limitations in the methodologies employed. In order to comprehensively comprehend the influence of sleep on post-stroke motor recovery, it is imperative to conduct further research employing robust study designs and objective sleep assessment techniques. Such investigations have the potential to enhance rehabilitation efforts and mitigate healthcare expenses.