Impact of Sleep Duration on Depression and Anxiety After Acute Ischemic Stroke

Fei Liu; Yang Yang; Shuo Wang; Xiao-Li Zhang; An-Xin Wang; Xiao-Ling Liao; Hong-Juan Fang; Yue Qu; Wei-Guo Ma; Ning Zhang; Chun-Xue Wang; Yong-Jun Wang

doi:10.3389/fneur.2021.630638

Impact of Sleep Duration on Depression and Anxiety After Acute Ischemic Stroke

Front Neurol. 2021 Mar 26:12:630638. doi: 10.3389/fneur.2021.630638. eCollection 2021.

Authors

Fei Liu^{1

2}, Yang Yang^{2

3}, Shuo Wang^{2

3}, Xiao-Li Zhang^{1

2}, An-Xin Wang^{1

2}, Xiao-Ling Liao^{1

2}, Hong-Juan Fang⁴, Yue Qu⁵, Wei-Guo Ma⁶, Ning Zhang^{2

3}, Chun-Xue Wang^{2

3

7}, Yong-Jun Wang^{1

2}

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁵ Independent Researcher, Ithaca, NY, United States.
⁶ Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁷ Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.

Abstract

Background: Abnormal sleep duration predicts depression and anxiety. We seek to evaluate the impact of sleep duration before stroke on the occurrence of depression and anxiety at 3 months after acute ischemic stroke (AIS). Methods: Nationally representative samples from the Third China National Stroke Registry were used to examine cognition and sleep impairment after AIS (CNSR-III-ICONS). Based on baseline sleep duration before onset of stroke as measured by using the Pittsburgh Sleep Quality Index (PSQI), 1,446 patients were divided into four groups: >7, 6-7, 5-6, and <5 h of sleep. Patients were followed up with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) for 3 months. Poststroke anxiety (PSA) was defined as GAD-7 of ≥5 and poststroke depression (PSD) as PHQ-9 of ≥5. The association of sleep duration with PSA and PSD was evaluated using multivariable logistic regression. Results: The incidences of PSA and PSD were 11.2 and 17.6% at 3 months, respectively. Compared to a sleep duration of >7 h, 5-6 h, and <5 h of sleep were identified as risk factors of PSA [odds ratio (OR), 1.95; 95% confidence interval (CI), 1.24-3.07; P < 0.01 and OR, 3.41; 95% CI, 1.94-6.04; P < 0.01) and PSD (OR, 1.47; 95% CI, 1.00-2.17; P = 0.04 and OR, 3.05; 95% CI, 1.85-5.02; P < 0.01), while 6-7 h of sleep was associated with neither PSA (OR, 1.09; 95% CI, 0.71-1.67; P = 0.68) nor PSD (OR, 0.92; 95% CI, 0.64-1.30; P = 0.64). In interaction analysis, the impact of sleep duration on PSA and PSD was not affected by gender (P = 0.68 and P = 0.29, respectively). Conclusions: Sleep duration of shorter than 6 h was predictive of anxiety and depression after ischemic stroke.

Keywords: ischemic stroke; post-stroke anxiety; post-stroke depression; prognosis; sleep duration.