0947 Sleep-wake Disturbances In The Post-acute Phase Of Stroke Impact Quality Of Life And Outcome

Abstract

The objective was to investigate the impact of sleep-wake disturbances (SWD) on cognitive function and quality of life measures in the post-acute phase of stroke. Sex differences were also investigated. Adult stroke (n=58) patients were assessed for SWD via overnight polysomnography. The mean age was 51 ± 2 years and mean latency from injury was 116 ± 13 days. Sleep measures included total sleep time (TST), sleep and REM latency, percent time in sleep stages, apnea/hypopnea index (AHI), wake after sleep onset (WASO), and arousal index. The primary outcome measures were: Montreal Cognitive Assessment (MoCA), Neuro-QoL and Mayo Portland Adaptability Inventory (MPAI). Women had lower AHI (F(1,51)=12.236, p<.01), fewer arousals (F(1,51)=7.184, p<.01), and spent significantly more time in SWS (F(1,51)=5.923, p<.05) than men; however, SWS was reduced in both sexes. SWS made up <3% of TST in 67% of patients. Analysis of NeuroQOL measures indicated the following: Longer latencies to sleep were associated with increases in subjective stigma and depression (p<.05), as well as decreases in positive affect (p<.05). Longer latencies to REM sleep were associated with increases in anxiety and emotional/behavioral dyscontrol (p<.05). Decreased sleep efficiency led to increased emotional/behavioral dyscontrol (p<.05). Increased time in REM sleep decreased subjective sleep disturbance (p<.05). Higher AHI and number of awakenings led to decreased ability to participate and positive affect (p<.05). Decreased sleep efficiency was associated with higher scores on the MPAI, indicating poorer outcomes with disrupted sleep (p<.05). Poorer outcomes measured by the MPAI were also associated with a higher percentage of WASO (p<.05). Male stroke patients display significantly higher AHI, and arousals, and spend significantly less time in SWS than female patients. For both sexes, objective sleep measures were significantly correlated with quality of life measures, where improved sleep indicated better subjective quality of life. Additionally, sleep measures were significantly correlated with outcome measures such as the MPAI. Apnea was not significantly correlated with BMI, which could be indicative of respiratory dysregulation driven by injury-related autonomic disturbances. Support (If Any)