Background <p>There is a wide debate on the bidirectional relationship between cerebrovascular diseases and sleep disorders. In this study we aim to assess the role of sleep disturbances as a risk factor of stroke by estimating the percentage of patients with sleep disorders prior to the occurrence of stroke compared with healthy controls.</p> Results <p>The study involved 93 patients with subcortical (63.44%), cortical (25.81%), and brain stem (10.75%) infarcts, matched with 50 controls, with a highly significant level of difference between both groups in blood pressure, inflammatory markers, and lipid profile. The patients with worse sleep score (PSQI) prior to stroke showed statistical significance in correlation with C-reactive protein (CRP) and fibrinogen levels. After regression analysis, factors affecting stroke severity included age, triglyceride level, and ESS prior to stroke occurrence.</p> Conclusion <p>Our findings establish a significant link between pre-stroke sleep disturbances, increased systemic inflammation (CRP, fibrinogen), and carotid atherosclerotic changes, proposing inflammation as a key mediator between poor sleep and ischemic stroke. Furthermore, pre-stroke sleepiness emerged as an independent contributor to initial stroke severity. These results advocate for the consideration of sleep quality not merely as a comorbid condition but as a modifiable risk factor and therapeutic target within comprehensive stroke care pathways.</p>