Examining the Inter-relations of Depression, Physical Function, and Cognition with Subjective Sleep Parameters among Stroke Survivors: A Cross-sectional Analysis

Jennifer C Davis; Ryan S Falck; John R Best; Patrick Chan; Stephanie Doherty; Teresa Liu-Ambrose

doi:10.1016/j.jstrokecerebrovasdis.2019.04.010

Examining the Inter-relations of Depression, Physical Function, and Cognition with Subjective Sleep Parameters among Stroke Survivors: A Cross-sectional Analysis

J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2115-2123. doi: 10.1016/j.jstrokecerebrovasdis.2019.04.010. Epub 2019 May 23.

Authors

Jennifer C Davis¹, Ryan S Falck², John R Best², Patrick Chan³, Stephanie Doherty³, Teresa Liu-Ambrose²

Affiliations

¹ Faculty of Management, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada; Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. Electronic address: jennifer.davis@ubc.ca.
² Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
³ Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia.

PMID: 31129108
DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.010

Abstract

Goal: Stroke survivors commonly experience depression as well as deficits in physical and cognition function. Emerging evidence also suggests sleep quality is compromised poststroke. Our primary objective was to examine the association of subjective sleep parameters (ie, total PSQI score) with depression, health related quality of life, physical function, and cognition among stroke survivors.

Materials and methods: Cross-sectional analysis of 72 older adults with chronic stroke (≥6 months postischemic stroke) enrolled in a randomized controlled trial of exercise or cognitive enrichment. Subjective sleep parameters were assessed using the Pittsburgh Sleep Quality Index (PSQI). We report total PSQI score and specific PSQI parameter scores (ie, PSQI-subjective sleep quality, PSQI-sleep latency, PSQI-sleep duration, PSQI-habitual sleep efficiency, PSQI-sleep disturbances, PSQI-use of sleep medication, and PSQI-daytime dysfunction). Bivariate correlations and multivariate linear regression assessed associations between subjective sleep parameters and depression/health related quality of life, physical function, and cognition.

Findings: For bivariate correlations, depression was significantly associated with global PSQI, PSQI-subjective sleep quality, PSQI-habitual sleep efficiency, and PSQI-daytime dysfunction. Health related quality of life was significantly associated with PSQI-sleep medication. Physical function and health was significantly associated with PSQI-subjective sleep quality, PSQI-sleep latency, PSQI-sleep duration, and PSQI-daytime dysfunction. Multivariate linear regression demonstrated that PSQI-daytime dysfunction predicted depression and physical function; PSQI-subjective sleep quality predicted depression. No significant associations between global PSQI subjective sleep parameters with cognition were observed.

Conclusion: Poor subjective sleep parameters and PSQI-subjective sleep quality among stroke survivors were associated with depression; PSQI-daytime dysfunction was associated with physical function. Thus, sleep should be considered in the management of those who have suffered a stroke to optimize poststroke rehabilitation outcomes.

Keywords: Chronic stroke; cognition; sleep quality.

MeSH terms

Affect*
Aged
Aged, 80 and over
Cognition Disorders / etiology*
Cognition Disorders / psychology
Cognition*
Cross-Sectional Studies
Depression / etiology*
Depression / psychology
Female
Health Status
Humans
Male
Mental Health
Middle Aged
Mobility Limitation
Postural Balance
Prognosis
Quality of Life*
Randomized Controlled Trials as Topic
Risk Factors
Sleep Wake Disorders / etiology*
Sleep Wake Disorders / physiopathology
Sleep Wake Disorders / psychology
Sleep*
Stroke / complications*
Stroke / diagnosis
Stroke / physiopathology
Stroke / psychology