The purpose of this study was to explore the evolution of SH at 10-, 60-, and 90-days post stroke and the cross sectional and longitudinal associations between SH and stroke outcomes.
People with stroke undergoing inpatient rehabilitation in the United States participated in the study. SH was measured using a combination of actigraphy (which was used to assess regularity, duration, continuity/efficiency, and timing dimensions of SH) that participants wore for 5-7 days at 10-, 60-, and 90-days post stroke and self-report (which was used to assess alertness/sleepiness and satisfaction/quality dimensions of SH). Each dimension was scored on a three-point ordinal scale (rarely/never, sometimes, usually/always), which resulted in SH scores ranging from 0 (poor SH) to 12 (good SH). Stroke outcomes were collected at the same time points and consisted of stroke severity (NIHSS), disability (mRS), cognition (MOCA), depression (PHQ-9), activity levels (steps/day and time sitting), and health-related quality of life (SIS). ANOVA was used to determine if there were differences in sleep health between 10, 60, and 90 days. Pearson correlation was used to examine the association between SH and stroke outcomes cross sectionally and longitudinally. Linear regression analysis was used to examine the association between SH at 10 days post stroke and health-related quality of life at 60- and 90-days post stroke.
Data from 86 participants were used in the analyses. SH was poor at all time points (10 days = 5.3 [2.1], 60 days = 5.5 [1.9] and 90 days = 5.5 [1.4]) and there was no significant difference in SH across the three time points (p>0.05). Cross sectionally at 10 days post stroke worse SH was significantly associated with greater stroke severity (r=-0.29), greater disability (r=-0.26), and more time sitting (r=-0.38); at 60 days post stroke worse SH was significantly associated with greater depression (r=-0.43) and poorer health-related quality of life (r=0.38); and at 90 days post stroke worse SH was significantly associated with greater depression (r=-0.55). SH at 10 days post stroke was significantly associated with poorer health-related quality of life at 60 days (r2=0.20) and 90 days (r2=0.13) post stroke.
People after stroke exhibit poor SH while in the hospital and this does not improve upon discharge home. Poor SH is associated with greater stroke severity, greater disability, greater sedentary time, lower health related quality of life, and higher levels of depression. Poor SH at 10 days post stroke was predictive of lower health related quality of life at 60- and 90-days post stroke.
Physical therapists should assess SH in people with stroke. SH may play an important role in recovery after stroke. Interventions to improve SH should be considered in combination with rehabilitation interventions to improve health-related quality of life.
Sleep Health
