Sleep and cognitive function in chronic stroke: a comparative cross-sectional study

Falck, Ryan S.; Best, John R.; Davis, Jennifer C.; Eng, Janice J.; Middleton, Laura; Hall, Peter A.; Liu-Ambrose, Teresa

doi:10.1093/sleep/zsz040

Cited by 37 publications

(28 citation statements)

References 89 publications

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“…It also would be important for future studies to explore whether the link between sleep disturbance and outcome is affected by cognitive impairment as we did not have a specific cognitive assessment. Falck et al 31 found that stroke survivors with disrupted sleep demonstrated larger impairments in cognitive performance relative to controls than those with low sleep fragmentation, suggesting that sleep disturbance may exacerbate cognitive problems after brain injury.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…A large number of studies have focused on analyzing the effect of sociodemographic factors [ 27 – 29 ], socioeconomic factors [ 30 – 32 ], and physiological factors on the cognitive function of elderly individuals [ 33 , 34 ]. However, few studies have examined the effects of CBCS on the cognitive function of elderly individuals.…”

Section: Introductionmentioning

confidence: 99%

The evolution trend of availability of China’s community-based care services and its impact on the cognitive function of elderly people: 2008-2018

Yue

Xiang

et al. 2021

Int J Equity Health

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Background To address the challenge of the aging population, community-based care services (CBCS) have been developed rapidly in China as a new way of satisfying the needs of elderly people. Few studies have described the evolution trend of availability of CBCS in rural and urban areas and evaluated their effectiveness. This study aims to show the availability of China’s CBCS and further analyze the effect of the CBCS on the cognitive function of elderly people. Methods Longitudinal analysis was performed using data from the 2008 to 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 23937 observations from 8421 elderly people were included in the study. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. We aggregated similar CBCS to generate three binary variable categories (daily life support, emotional comfort and entertainment services, medical support and health services) indicating the availability of CBCS (1 = yes, 0 = no). Multilevel growth models were employed to estimate the association between CBCS and cognitive function while adjusting for many demographic and socioeconomic characteristics. Results The availability of CBCS increased a lot from 2008 to 2018 in China. Although the availability of CBCS in urban areas was higher than that in rural areas in 2008, by 2018 the gap narrowed significantly. Emotional comfort and entertainment services (B = 0.331, 95% CI = 0.090 to 0.572) and medical support and health services (B = 1.041, 95% CI = 0.854 to 1.228) were significantly and positively associated with cognitive function after adjusting for the covariates. Conclusion There was a significant increase in the availability of CBCS from 2008 to 2018 in China. This study sheds light on the positive correlation between CBCS and cognitive function among Chinese elderly individuals. The results suggest that policymakers should pay more attention to the development of CBCS and the equity of the supply of CBCS in urban and rural areas.

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“…23 In addition, patients with stroke and poor sleep quality have worse performance on objective measures of cognition compared with controls without stroke with poor sleep quality. 24 Similarly, data on the association of sleep disturbance and patient-reported physical function in patients with stroke are limited, but there are substantial data on the association between clinician-reported functional status and sleep disturbance in patients with stroke. 25 It is notable, therefore, that patients with greater clinician-reported disability in our cohort (defined as mRS 4-5) had less sleep disturbance.…”

Section: Discussionmentioning

confidence: 99%

Sleep disturbance predicts future health status after stroke

Katzan

Thompson

Walia

et al. 2020

Journal of Clinical Sleep Medicine

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Study Objectives: We evaluated factors associated with the presence of sleep disturbance in patients with stroke and whether sleep disturbance predicted change in other patient-reported domains of health over time. Methods: Observational cohort study of 2,190 patients with stroke seen in a cerebrovascular clinic February 17, 2015 to July 5, 2017 who completed patientreported outcome measures (PROMs) at ≥ 1 visit, including the Patient Health Questionnaire-9 depression screen, Quality of Life in Neurological Disorders (NeuroQoL) cognitive function and Patient-Reported Outcomes Information Measurement System (PROMIS) sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. Separate multivariable models were constructed with PROMIS sleep disturbance as the dependent variable. Covariates included clinical and demographic variables, the Patient Health Questionnaire-9 depression screen scored on the PROMIS metric, and 1 of the 6 other PROMs. Among the 476 patients with ≥ 2 visits, linear regression models were constructed to determine the association of baseline sleep disturbance with follow-up PROMs after adjustment for the corresponding baseline PROMIS/NeuroQol scores, depression score, and clinical variables. Results: Younger age and all PROM scores were associated with sleep disturbance; depression had the greatest association among PROMs (beta estimate 0.53, 95% confidence interval, 0.49, 0.57), physical function had the least (−0.06, 95% confidence interval, −0.11, −0.01). Baseline PROMIS sleep disturbance score was associated with worse adjusted follow-up scores for depression, fatigue, social role satisfaction, and physical function. Conclusions: Younger age and all 8 PROMs were associated with sleep disturbance in patients with stroke. The degree of sleep disturbance predicted future patient-reported outcomes for multiple domains of health. Further study is warranted to determine if interventions shown to improve sleep symptoms will also improve other outcomes.

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Sleep and cognitive function in chronic stroke: a comparative cross-sectional study

Cited by 37 publications

References 89 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

The evolution trend of availability of China’s community-based care services and its impact on the cognitive function of elderly people: 2008-2018

Sleep disturbance predicts future health status after stroke

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