Functional recovery after ischemic stroke: Impact of different sleep health parameters

Abstract

SummarySleep disturbances after ischaemic stroke include alterations of sleep architecture, obstructive sleep apnea, restless legs syndrome, daytime sleepiness and insomnia. Our aim was to explore their impacts on functional outcomes at month 3 after stroke, and to assess the benefit of continuous positive airway pressure in patients with severe obstructive sleep apnea. Ninety patients with supra‐tentorial ischaemic stroke underwent clinical screening for sleep disorders and polysomnography at day 15 ± 4 after stroke in a multisite study. Patients with severe obstructive apnea (apnea–hypopnea index ≥ 30 per hr) were randomized into two groups: continuous positive airway pressure‐treated and sham (1:1 ratio). Functional independence was assessed with the Barthel Index at month 3 after stroke in function of apnea–hypopnea index severity and treatment group. Secondary objectives were disability (modified Rankin score) and National Institute of Health Stroke Scale according to apnea–hypopnea index. Sixty‐one patients (71.8 years, 42.6% men) completed the study: 51 (83.6%) had obstructive apnea (21.3% severe apnea), 10 (16.7%) daytime sleepiness, 13 (24.1%) insomnia, 3 (5.7%) depression, and 20 (34.5%) restless legs syndrome. Barthel Index, modified Rankin score and Stroke Scale were similar at baseline and 3 months post‐stroke in the different obstructive sleep apnea groups. Changes at 3 months in those three scores were similar in continuous positive airway pressure versus sham‐continuous positive airway pressure patients. In patients with worse clinical outcomes at month 3, mean nocturnal oxygen saturation was lower whereas there was no association with apnea–hypopnea index. Poorer outcomes at 3 months were also associated with insomnia, restless legs syndrome, depressive symptoms, and decreased total sleep time and rapid eye movement sleep.

Trajectories of self-reported daytime sleepiness post-ischemic stroke and transient ischemic attack: A propensity score matching study versus non-stroke patients

“…16 Stroke lesion localizations, and especially subcortical, ponto-mesencephalic lesions, 12 and thalamic stroke, 17,18 as well as restless legs syndrome, diabetes, and higher body mass index are factors associated with post-stroke EDS. 13,19 Surprisingly, for a given severity of obstructive SA, patients with stroke reported less EDS in comparison with OSA free of stroke. 20 The trajectories of self-reported sleepiness poststroke and interactions with comorbid SA and CPAP treatment have not been studied.…”

“…Data regarding the temporal evolution of post-stroke EDS are scarce. Denis et al 13 in a prospective study including 90 patients with supra-tentorial ischemic stroke, found EDS in 16.7% of patients at 15 ± 4 days following stroke, and in 18.7% at 3 months. Duss et al, 14 in a prospective longitudinal study, found the prevalence of EDS ranging between 10% and 14% from 1 month to 2 years post-stroke and transient ischemic attack (TIA), with a significant decrease in mean ESS scores at 2 years compared to 1 month after stroke/TIA.…”