Association between sleep-disordered breathing and post-stroke fatigue in patients with ischemic stroke

J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107701. doi: 10.1016/j.jstrokecerebrovasdis.2024.107701. Epub 2024 Mar 30.

Abstract

Objectives: Post-stroke fatigue (PSF) is common and often disabling. Sleep-disordered breathing (SDB) is highly prevalent among stroke survivors and can cause fatigue. We explored the relationship between SDB and PSF over time.

Materials and methods: Ischemic stroke (IS) patients within the BASIC project were offered SDB screening with a well-validated cardiopulmonary sleep apnea test at 0, 3-, 6-, and 12-months post-stroke. The primary exposure was the respiratory event index (REI; sum of apneas plus hypopneas per hour). The primary outcome was PSF, measured by the SF-36 vitality scale. Associations between REI and PSF were evaluated using linear regression including time-by-REI interactions, allowing the effect of REI to vary over time.

Results: Of the 411 IS patients who completed at least one outcome interview, 44 % were female, 61 % Mexican American (MA), 26 % non-Hispanic white, with a mean age of 64 (SD 10). Averaged across timepoints, REI was not associated with PSF. In a time-varying model, higher REI was associated with greater PSF at 3-months (β = 1.75, CI = 0.08, 3.43), but not at 6- or 12-months. Across timepoints, female sex, depressive symptoms, and comorbidity burden were associated with greater PSF, whereas MA ethnicity was associated with less PSF.

Conclusions: Higher REI was associated with modestly greater PSF in the early post-stroke period, but no association was observed at 6 months and beyond. SDB may be a modest modifiable risk factor for early PSF, but its treatment is unlikely to have a substantial impact on long-term PSF. MA ethnicity seems to be protective against PSF.

Keywords: Ethnicity; Post-stroke fatigue; Sleep apnea; Sleep disordered breathing.

MeSH terms

  • Aged
  • Fatigue* / diagnosis
  • Fatigue* / epidemiology
  • Fatigue* / etiology
  • Fatigue* / physiopathology
  • Fatigue* / psychology
  • Female
  • Humans
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / epidemiology
  • Ischemic Stroke* / ethnology
  • Male
  • Middle Aged
  • Prognosis
  • Respiration
  • Risk Assessment
  • Risk Factors
  • Sleep
  • Sleep Apnea Syndromes* / diagnosis
  • Sleep Apnea Syndromes* / epidemiology
  • Sleep Apnea Syndromes* / ethnology
  • Sleep Apnea Syndromes* / physiopathology
  • Time Factors