Sleep-related symptoms in patients with mild stroke

Irene L Katzan; Nicolas R Thompson; Harneet K Walia; Douglas E Moul; Nancy Foldvary-Schaefer

doi:10.5664/jcsm.8122

Sleep-related symptoms in patients with mild stroke

J Clin Sleep Med. 2020 Jan 15;16(1):55-64. doi: 10.5664/jcsm.8122. Epub 2019 Dec 4.

Authors

Irene L Katzan^{1

2}, Nicolas R Thompson¹, Harneet K Walia³, Douglas E Moul³, Nancy Foldvary-Schaefer³

Affiliations

¹ Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, Ohio.
² Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
³ Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.

Abstract

Study objectives: Treatable sleep-related conditions are frequent in stroke patients, although their prevalence across stroke types and ideal method for screening is not clear. The objectives of this study were to evaluate the prevalence of sleep disturbance across different stroke types and identify approaches to the collection of sleep-related measures in clinical practice.

Methods: We performed an observational cohort study of 2,213 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or transient ischemic attack seen in a cerebrovascular clinic February 17, 2015 through July 5, 2017 who completed at least one of the following sleep-related questionnaires: Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance, Insomnia Severity Index (ISI), Sleep Apnea Probability Scale (SAPS), and sleep duration. Prevalence of abnormal scores were calculated using the following thresholds: PROMIS sleep disturbance ≥ 55, ISI ≥ 15, SAPS score ≥ 0.50, and sleep duration fewer than 6 or more than 9 hours. Sensitivity, specificity, and positive and negative predictive values of PROMIS sleep disturbance T-score ≥ 55 to identify patients with moderate-severe insomnia (ISI ≥ 15) were computed.

Results: In the cohort, 28.6% patients (624/2183) had PROMIS sleep disturbance score ≥ 55, 17.6% (142/808) had ISI ≥ 15, and 61.3% (761/1241) had a positive SAPS screen. The frequency of abnormal sleep scale scores was similar across time periods and stroke types. The sensitivity and specificity of PROMIS sleep disturbance T-score ≥ 55 to identify patients with ISI ≥ 15 were 0.89 (95% confidence interval 0.83-0.94) and 0.81 (95% confidence interval 0.78-0.84), respectively.

Conclusions: The prevalence of sleep-related symptoms in patients with mild stroke are similar across stroke types and time periods after stroke. Potential approaches to screening for sleep disturbance in stroke patients are provided.

Keywords: patient-reported outcomes; sleep; stroke.

Publication types

Observational Study

MeSH terms

Humans
Sleep
Sleep Initiation and Maintenance Disorders* / epidemiology
Sleep Wake Disorders* / epidemiology
Stroke* / complications
Stroke* / epidemiology
Surveys and Questionnaires