Sleep disturbance predicts future health status after stroke

Abstract

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.

Use of Patient-Reported Outcomes Measurement Information System Measures in Clinical Research in Patients With Stroke: A Systematic Literature Review

“…The characteristics of the included 27 studies (24,366 patients in total) are summarized in table 1 . 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 Studies were predominantly from the United States origin (22 of 27; 81%). The majority of the studies concerned hospital-based populations with stroke, describing the outcomes of a prospective or retrospective outpatient cohort according to data gathered in regular care, at regular poststroke care visits (20 of 27; 74%).…”

“…Sleep Disturbance 1.0. Fatigue 1.0 Katzan et al 34 Physical Function (CAT). Satisfaction With Social Roles and Activities (CAT).…”

The Mediating Role of Sleep Disturbance on the Association Between Stress and Self-Rated Health Among Chinese and Korean Immigrant Americans

“…These hormones interfere with the body's ability to maintain quality sleep (27). Poor sleep health may then result in risk of inflammatory disease by increasing the levels of C-reactive protein and interleukin-6 (12). Another mechanism linking poor sleep to disease risk is decreased serotonin, a neurotransmitter that regulates normal circadian rhythms and is also at low levels in people with depression (14).…”

“…Research suggests that many Asian Americans likely somaticize stressful experiences into physical symptoms such as sleep disturbances (10,11). Sleep disturbances lead to poor mental and physical functioning, including greater risk of inflammation, chronic diseases, and multimorbidity (12)(13)(14).…”

Home-based light therapy for fatigue following acquired brain injury: a pilot randomized controlled trial

“…Frequent sleep disturbances include excessive daytime sleepiness (EDS), hypersomnia, insomnia, reduced sleep efficiency, changes to sleep timing and sleep apnea [ 7 – 9 ]. Sleep may be disrupted by damage to structures involved in homeostatic regulation of sleep and wakefulness, including the hypothalamus and brain stem [ 10 ], and by secondary factors including depression and pain [ 11 – 13 ].…”