Impact of Persistent Poor Sleep Quality on Post-Stroke Anxiety and Depression: A National Prospective Clinical Registry Study

Xiao-Wei Fan; Yang Yang; Shuo Wang; Yi-Jun Zhang; An-Xin Wang; Xiao-Ling Liao; Wei-Guo Ma; Ning Zhang; Chun-Xue Wang; Yong-Jun Wang

doi:10.2147/NSS.S357536

Impact of Persistent Poor Sleep Quality on Post-Stroke Anxiety and Depression: A National Prospective Clinical Registry Study

Nat Sci Sleep. 2022 Jun 13:14:1125-1135. doi: 10.2147/NSS.S357536. eCollection 2022.

Authors

Xiao-Wei Fan^#^{1

2

3

4}, Yang Yang^#^{2

3

4

5}, Shuo Wang^{2

3

4

5}, Yi-Jun Zhang^{1

2

3

4}, An-Xin Wang^{1

2

3

4}, Xiao-Ling Liao^{1

2

3

4}, Wei-Guo Ma⁶, Ning Zhang^{2

3

4

5}, Chun-Xue Wang^{2

3

4

5

7}, Yong-Jun Wang^{1

2

3

4}

Affiliations

¹ Department of Neurology, Capital Medical University, Beijing, People's Republic of China.
² Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
³ China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
⁴ Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
⁵ Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Capital Medical University, Beijing, People's Republic of China.
⁶ Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
⁷ Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: The impact of poor sleep quality after stroke, especially persistent poor sleep quality, on poststroke anxiety and depression is unclear. We seek to investigate the impact of baseline and persistent poor sleep quality on short-term poststroke anxiety and depression.

Patients and methods: Data were analyzed for 1619 patients with acute ischemic stroke from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients study (ICONS). The sleep quality was assessed at 2 weeks and 3 months using the Pittsburgh Sleep Quality Index scale (PSQI). Poor sleep quality was defined as a PSQI score of >5, and persistent poor sleep quality was defined as a PSQI score of >5 at each time point. Patients were divided into three groups according to the quality of sleep: good sleep quality, baseline poor sleep quality and persistent poor sleep quality. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 scale (GAD-7), and Modified Rankin Scale (mRS) at 3 months after stroke were taken as the study outcomes.

Results: Persistent poor sleep quality was present in 70.2% of patients after stroke. Compared to those with good sleep quality, patients with baseline poor sleep quality did not show significant differences in disability, anxiety and depression. However, patients with persistent poor sleep were at increased risk of depression (odds ratio, OR 3.04, 95% confidence interval, CI 1.66-5.57, P < 0.01) and anxiety (OR 3.20, 95% CI 1.42-7.19, P < 0.01) at 3 months after stroke. Persistent poor sleep quality was not identified as a risk factor for functional disability at 3 months.

Conclusion: Patients with persistent poor sleep quality are at added risks for depression and anxiety after stroke.

Keywords: anxiety; depression; ischemic stroke; sleep quality.

Grants and funding

This work was supported by grants from the National Key Research and Development Program of China (2020YFC2005300), Talents Project of Beijing (2018000021469G235), Dongcheng District Talents Project of Beijing (DCQYYRC-789-01-DR), Youth Research Funding, Beijing Tiantan Hospital, Capital Medical University (2018-YQN-18) and Beijing Key Clinical Specialty Program.