Sleep Health During Recovery After Stroke

Study Objectives People with stroke are susceptible to developing sleep disorders, which may negatively impact recovery. Little is known about sleep health (SH) broadly and its impact on recovery after stroke. The purpose of this study was to explore factors that are associated with SH during recovery after stroke.

Data were collected from 90 participants at 10-, 60-, and 90-days post stroke without moderate to severe obstructive sleep apnea. Sleep health was measured by combining data from actigraphy and self-report to create an SH score that reflected regularity, satisfaction, alertness, timing, efficiency, and duration of sleep. Factors that may be associated with SH that were collected were Patient Health Questionnaire 9 (PHQ-9), Montreal Cognitive Assessment (MOCA), Barthel Index (BI), gait speed (GS), oxygen desaturation index (ODI), age, and sex. A cumulative link mixed model (CLMM) was used to determine the association between SH and the independent factors.

The CLMM found that the PHQ-9 had a significant negative estimate of-0.116 (p = 0.0002) and that the BI had a significant estimate of 0.016 (p = 0.044). Indicating that higher depressive symptoms and lower functional ability are associated with poorer SH. Time post stroke was not associated with SH

We identified depression and functional ability as significant determinants of SH. Participants exhibited poor SH while in the hospital and it remained unchanged at 60 and 90 days after stroke. Further evaluation of the likely bidirectional relationship between depression/functional impairment and SH after stroke may lead to targets to improve stroke recovery and SH. Competing Interest Statement This work was supported by the National Institutes of Health NINR, Award Number R01NR018979 Funding Statement This study was funded by the National Institutes of Health NINR, Award Number R01NR018979 Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of WCG gave ethical approval for this work IRB of SUNY Upstate Medical University gave ethical approval for this work IRB of University of Kansas gave ethical approval for this work IRB of Emory University gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes All authors have read and approved this manuscript. The authors have no conflicts of interest related to this manuscript. Funding Support: This work was supported by the National Institutes of Health NINR, Award Number R01NR018979 Data Availability Data are not available for this study at the present time.