Objective Sleep Measures in Inpatients With Subacute Stroke Associated With Levels and Improvements in Activities of Daily Living

Abstract

Objective: To investigate whether objective polysomnographic measures of prevalent sleep problems such as sleep-disordered-breathing (SDB) and insomnia are associated with activities of daily living levels in inpatients at rehabilitation units.

Design: Retrospective and observational study.

Setting: Single rehabilitation center.

Participants: Inpatients with subacute stroke (N=123) (61.6±13.1 years; 23.8±3.4 kg/m²; 33% women; 90.5±36.7 days post-stroke) underwent a 1-night polysomnographic study and a 1-month inpatient rehabilitation program.

Main outcome measures: Admission and discharge Barthel Index (BI) scores and its change scores.

Results: One hundred three (92%) patients had moderate-to-severe SDB (46.7±25.1 events/h in the apnea-hypopnea index), and 24 (19.5%) patients had acceptable continuous positive airway pressure adherence. Diverse values were found for total sleep time (259±71 min), sleep efficiency (69.5%±19.3%), sleep latency (24.3±30.9 min), and wakefulness after sleep onset (93.1±74.2 min). Admission BI scores and the BI change scores were 33.8±23.2 and 10.1±9.2, respectively. The National Institutes of Health Stroke Scale (NIHSS, 10.2±5.6), available in 57 (46%) patients, was negatively associated with admission levels and gains in BI change scores (P<.001, =0.002, respectively) in a univariate analysis. In regression models with backward selection, excluding NIHSS score, both age (P=.025) and wakefulness after sleep onset (P<.001) were negatively associated (adjusted R²=0.260) with admission BI scores. Comorbidity of hypertension; sleep latency percentage of stage 1, non-rapid eye movement sleep; and desaturation events ≥4% (P<.001, 0.001, 0.021, and 0.043, respectively; adjusted R²=0.252) were negatively associated with BI score gains.

Conclusions: Based on objective sleep measures, insomnia rather than SDB in inpatients with subacute stroke was associated negatively with admission levels of activity of daily living and its improvement after a 1-month rehabilitation course.

Keywords: Cerebrovascular disease; Hypertension; Insomnia; Prognosis; Sleep apnea.