Poor Sleep Quality I Related to Impaired Functional Status Following Stroke

Sönmez, İpek; Karasel, Seide

doi:10.1016/j.jstrokecerebrovasdis.2019.104349

Cited by 26 publications

(24 citation statements)

References 19 publications

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“…Siccoli et al 11 demonstrated a cross-sectional correlation between the National Institute for Health Stroke Scale (NIHSS) score and wake after sleep onset (WASO), in a small sample of acute stroke patients. A larger study 12 found a cross-sectional relationship between subjective sleep quality and the functional ambulation score after stroke but had no objective sleep measures. Similarly, Kalmbach et al 13 found that patients with subjective difficulties initiating sleep had lower function at multiple time-points over the first 6 months of recovery from traumatic brain injury (TBI).…”

Section: Introductionmentioning

confidence: 94%

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Fleming

Smejka

Slater

et al. 2020

Neurorehabil Neural Repair

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Background. Sleep is important for consolidation of motor learning, but brain injury may affect sleep continuity and therefore rehabilitation outcomes. Objective. This study aims to assess the relationship between sleep quality and motor recovery in brain injury patients receiving inpatient rehabilitation. Methods. Fifty-nine patients with brain injury were recruited from 2 specialist inpatient rehabilitation units. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included Action Research Arm test (upper limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead Mobility Index. The Functional Independence Measure (FIM) was assessed at admission and discharge by the clinical team. Fifty-five age- and gender-matched healthy controls completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality ( P < .001) and more fragmented sleep ( P < .001) than controls. For inpatients, sleep fragmentation explained significant additional variance in motor outcomes, over and above that explained by admission FIM score ( P < .017), such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM ( R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions. Inpatients with brain injury demonstrate impaired sleep quality, and this is associated with poorer motor outcomes and slower functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.

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Section: Introductionmentioning

confidence: 94%

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Fleming

Smejka

Slater

et al. 2020

Neurorehabil Neural Repair

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“…Although no previous studies have specifically examined the relationship between motor impairment and sleep disruption measures at the chronic stage of stroke, generally it has been reported that people with more severe stroke self-report worse sleep quality. 14 , 15 , 34 The lack of findings here suggests that the relationships found previously may be influenced by other factors that contribute to stroke severity scores, over and above motor impairment. Information on stroke severity (eg clinical stroke severity scores or lesion volumes) was not available or collected in the current study and therefore we are unable to test this possibility directly.…”

Section: Discussionmentioning

confidence: 60%

Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

Fleming

Smejka

Slater

et al. 2021

Neurorehabil Neural Repair

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Background. Stroke survivors commonly complain of difficulty sleeping. Poor sleep is associated with reduced quality of life and more understanding of long-term consequences of stroke on sleep is needed. Objective. The primary aims were to (1) compare sleep measures between chronic stroke survivors and healthy controls and (2) test for a relationship between motor impairment, time since stroke and sleep. Secondary aims were to explore mood and inactivity as potential correlates of sleep and test the correlation between self-reported and objective sleep measures. Methods. Cross-sectional sleep measures were obtained for 69 chronic stroke survivors (mean 65 months post-stroke, 63 years old, 24 female) and 63 healthy controls (mean 61 years old, 27 female). Self-reported sleep was assessed with the sleep condition indicator (SCI) and sleep diary ratings, objective sleep with 7-nights actigraphy and mood with the Hospital Anxiety and Depression Scale. Upper extremity motor impairment was assessed with the Fugl-Meyer assessment. Results. Stroke survivors had significantly poorer SCI score ( P < .001) and higher wake after sleep onset ( P = .005) than controls. Neither motor impairment, nor time since stroke, explained significant variance in sleep measures for the stroke group. For all participants together, greater depression was associated with poorer SCI score ( R2adj = .197, P < .001) and higher age with more fragmented sleep ( R2adj = .108, P < .001). There were weak correlations between nightly sleep ratings and actigraphy sleep measures ( r s = .15–.24). Conclusions. Sleep disturbance is present long-term after stroke. Depressive symptoms may present a modifiable factor which should be investigated alongside techniques to improve sleep in this population.

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“…In a meta-analysis, sleep efficiency was found to be lower in stroke patients than in controls (69%-79% vs 78%-78%, p = 0.006) [19]. Improving sleep quality is essential in stroke patients because poor sleep quality is associated with impaired functional status [20]. However, HFNC therapy was insufficient in improving sleep quality possibly due to unchanged AHI and noise-induced sleep disruption.…”

Section: Discussionmentioning

confidence: 99%

Effect of High-Flow Nasal Cannula on Sleep-disordered Breathing and Sleep Quality in Patients With Acute Stroke

Nakanishi

Suzuki

Ishihara

et al. 2020

Cureus

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Introduction Sleep-disordered breathing (SDB) is common after stroke. Although the standard treatment of SDB is continuous positive airway pressure (CPAP) ventilation, the patient's intolerance and discomfort result in low adherence rates. Alternatively, high-flow nasal cannula (HFNC) may be useful as it reduces upper airway collapse with low level of positive pressure and well tolerability. The aim of this study was to investigate whether HFNC therapy reduces SDB and improves sleep quality with higher compliance rate. Methods We included acute stroke patients with SDB for the assessment of apnea-hypopnea index (AHI) >5/h using WatchPAT 200 (Itamar Medical Ltd, Caesarea, Israel). Patients who met inclusion criteria received HFNC therapy (40 L/min) with monitoring by WatchPAT. AHI, oxygen desaturation index (ODI), sleep efficiency, and rapid eye movement (REM) sleep were compared in patients with and without HFNC therapy. We also evaluated the patient's comfort of HFNC therapy (discomfort or not). Results Among 17 patients assessed for AHI, 12 received HFNC therapy. HFNC therapy was not adhered in two patients due to intolerance. Eight patients remained for final analysis. There were no differences in SDB and sleep quality with and without HFNC therapy as follows: HFNC therapy vs control; AHI 24.9 ± 20.1 vs 21.3 ± 15.0/h (p = 0.63), ODI 16.2 ± 16.5 vs 12.9 ± 12.3/h (p = 0.54), sleep efficiency 80.4 ± 12.9 vs 87.1 ± 6.2 (p = 0.28), percentage of REM sleep 19.4% ± 9.6% vs 27.6% ± 8.9% (p = 0.07). Two patients (17%) complained of discomfort among eight patients. Conclusion HFNC therapy did not improve SDB and sleep quality. Nonadherence and discomfort were observed in HFNC therapy. We need a large trial to confirm this result.

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Poor Sleep Quality I Related to Impaired Functional Status Following Stroke

Cited by 26 publications

References 19 publications

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

Effect of High-Flow Nasal Cannula on Sleep-disordered Breathing and Sleep Quality in Patients With Acute Stroke

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