The critical influence of nocturnal breathing complaints on the quality of sleep after stroke: the Pittsburgh Sleep Quality Index and STOP-BANG

Presence of Self-Reported Sleep Alterations After Stroke and Their Relationship With Disability: A Longitudinal Study

BACKGROUND

Sleep disorders have a prevalence of 30% to 70% in post-stroke individuals. The presence of sleep disorders and poor sleep quality after stroke can affect important functions and lead to worse outcomes. However, most studies are restricted to the acute post-stroke stage only.

OBJECTIVE

To investigate the frequency of self-reported sleep alterations in a sample of chronic stroke individuals and to identify which self-reported sleep alterations were associated with disability.

METHODS

Prospective exploratory study. Self-reported sleep alterations were measured by the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and STOP-Bang Questionnaire. The dependent variable was measured 3 years after the first contact by the Modified Rankin Scale (mRS). Step-wise multiple linear regression analysis was employed to identify which sleep alterations were associated with disability.

RESULTS

Sixty-five individuals with stroke participated. About 67.7% of participants had poor sleep quality, 52.4% reported insomnia symptoms, 33.9% reported excessive daytime sleepiness, and 80.0% were classified as intermediate or high risk for obstructive sleep apnea. Only risk for obstructive sleep apnea was significantly associated with disability and explained 5% of the variance in the mRS scores.

CONCLUSION

Self-reported sleep alterations had a considerable frequency in a sample of chronic stroke individuals. The risk of obstructive sleep apnea was associated with disability in the chronic stage of stroke. Sleep alterations must be considered and evaluated in the rehabilitation process even after a long period since the stroke onset.

The Importance of Sleep for Successful Neurorehabilitation after Stroke

Sleep has important clinical implications for neurorehabilitation after stroke. We aimed to systematically explore sleep (including naps) as an essential factor in the neurorehabilitation of patients after stroke. After titles and abstracts were screened, 49 full texts were reviewed, and 7 were included in this review. Data were extracted and assessed for quality and risk of bias. We looked at any neurorehabilitation setting, and compared sleep with no sleep and explored these factors in stroke patients versus healthy individuals. Rehabilitation is critical for many activities that may need to be learned or re-learned following stroke and for returning to everyday life. In this context, sleep is essential in neurorehabilitation and physical therapy practice as it supports neuroplasticity, memory, and learning. The available data suggest that sleep should be considered in the treatment plan for successfully targeted physiotherapy to optimize cognitive and motor learning. Physical therapists should advise about sleep hygiene and therapies to improve sleep, both quality and quantity.

Factors Affecting the Quality of Sleep and Social Participation of Stroke Patients

(1) Background: Stroke patients are exposed to various psychosocial factors, such as depression, anxiety, and stress, which can cause problems with respect to their quality of sleep and social participation. (2) Objectives: We analyzed the causal relationships between the factors affecting sleep quality and social participation in hospitalized and community-based stroke patients using a path analysis model. (3) Methods: A questionnaire survey was administered to stroke patients from June to November 2020 using the Pittsburgh Sleep Quality Index to assess sleep quality; the Beck Depression Inventory to assess depression; the Beck Anxiety Inventory to assess anxiety; the Stress Scale to assess stress; and the Reintegration to Normal Living Index to assess participation. The data thus obtained were subjected to descriptive statistics, frequency analysis, and Pearson correlation analysis. In addition, anxiety, stress, and spasticity were set as exogenous variables to perform path analysis of their causal effects on depression (parameter), sleep quality, and social participation (final endogenous variables). (4) Results: In total, 145 people participated in this study, and the data of 129 people, excluding 16 insincere respondents, were analyzed. The general characteristics of the subjects comprised 84 males (65.1%) and 45 females (34.9%). Poor sleep quality comprised 54.3%, and good sleep quality comprised 45.7%, where the average age was 58.29 ± 15.46 years and the duration from onset was 39.73 ± 51.49 months. This study confirmed correlations between social participation and sleep quality, spasticity, depression, anxiety, and stress. Path analysis also revealed that anxiety and stress led to depression and that depression is a risk factor for sleep quality and social participation. (5) Conclusions: Sleep quality and social participation in stroke patients play an important role in rehabilitation. By carrying out this study, direct and indirect factors that affect sleep quality and social participation were analyzed, and the quality level in rehabilitation treatment should be improved from a structural point of view when approaching psychosocial factors.

The association between sleep disturbances and tooth loss among post-stroke patients

ABSTRACT Background: Loss of teeth has been associated with neurological and sleep disorders. It is considered to be a predictor of stroke and leads to modifications of airway patency and predisposition to obstructive sleep apnea. Objective: To investigate sleep quality, risk of obstructive sleep apnea and excessive sleepiness among post-stroke patients with tooth loss attending the Neurovascular Clinic of the Federal University of São Paulo. Methods: The prevalence rates of different types of stroke were assessed among 130 patients with different degrees of tooth loss, along with the presence of sleep disturbances, risk of obstructive sleep apnea and excessive daytime sleepiness. Results: The prevalence of ischemic stroke was 94.6%, with either no significant disability or slight disability. Our sample had poor sleep quality, and a high risk of obstructive sleep apnea, but without excessive daytime sleepiness. Half of our sample had lost between 9 and 31 teeth, and more than 25% had edentulism. The majority used full removable dental prostheses, and more than half of these individuals slept without removing the prosthesis. Conclusions: We found high prevalence of poor sleep quality and high risk of obstructive sleep apnea among post-stroke patients with tooth loss. This indicates the need for further studies on treating and preventing sleep disturbances in stroke patients with tooth loss.

Social support and sleep quality in patients with stroke: The mediating roles of depression and anxiety symptoms

BACKGROUND

Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living and social participation, but the relationship between social support and sleep quality remains unknown.

AIMS

This study aimed to assess the incidence of poor sleep quality, clarify the relationship between social support and sleep quality amongst stroke patients and determine whether anxiety and depression symptoms mediate this relationship.

METHODS

We conducted a quantitative, cross-sectional study involving 238 patients with stroke (median age of 61 [range 29-87] years, 68.1% male) recruited from a comprehensive tertiary care hospital between September 2019 and January 2020. A self-administered, structured questionnaire was used for the survey. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 4 (parallel mediation) of the SPSS PROCESS macro.

RESULTS

Results showed that the incidence of poor sleep quality amongst stroke patients was 65%. Mediation analysis showed that social support exerted significant direct effects on sleep quality, and anxiety and depression symptoms mediated the relationship between social support and sleep quality.

CONCLUSION

Measures should be taken to enhance social support to improve the sleep quality of stroke patients.

SUMMARY STATEMENT

What is already known about this topic? Patients with stroke have a high rate of sleep disorders, anxiety and depression symptoms. Anxiety and depression symptoms have a negative effect on sleep quality. Social support may be an effective intervention to reduce anxiety and depression symptoms and improve sleep quality amongst stroke patients. What this paper adds? The incidence of poor sleep was high amongst stroke patients. Social support had a direct positive effect on sleep quality. Anxiety and depression symptoms played multiple mediating roles in the relationship between social support and sleep quality. The implications of this paper: Our study adds to the existing literature by clarifying how social support impacts the sleep quality of stroke patients. We suggested improving the sleep quality of stroke patients through enhancing social support and reducing anxiety and depression symptoms, especially in patients with low levels of social support.

A hemispheric comparison of cognitive dysfunction and sleep quality impairment in Middle Cerebral Artery infarction

Objectives:

To investigate the severity of cognitive dysfunction and sleep quality impairment in patients with middle cerebral artery (MCA) strokes across the left and right hemisphere. Moreover, it also study gender differences with respect to MCA strokes.

Methods:

The study was conducted from February 2019 - May 2019 at COMSATS University, Islamabad. A total sample size of N=55 middle cerebral artery ischemic infarct patients was selected with N=29 left middle cerebral artery ischemic infarct patients and N=26 right middle cerebral artery ischemic infarct patients. The sample was assessed on The Neurocognitive Assessment Battery for stroke patients (N-CABS) & The Pittsburgh Sleep Quality Index-Urdu (PSQI-U).

Results:

The mean age of the sample was 50.96 years. There was a significant difference among scores of cognitive dysfunction between Left MCA (M=47.28, SD=12.87) and Right MCA stroke patients (M=29.7, S=21.41), t (53) =-6.80, p<0.001. Similarly, there was significant difference among scores of sleep disturbance between Left MCA (M=6.90, SD=2.93) and Right MCA (M=10.35, SD=3.97), t (53) =-3.68, p<0.001. Gender comparisons reveal that there is no significant difference between males and females for both, cognitive dysfunction and sleep quality impairment.

Conclusions:

Cognitive dysfunction and sleep quality impairment due to MCA strokes is significant between left and right hemispheres respectively, regardless of gender, assessed with N-CABS and PSQI-U. Further studies are required to analyse other demographic correlates related to MCA strokes.