Abstract
Abstract Introduction The objective was to investigate the impact of sleep-wake disturbances (SWD) on cognition and quality of life in the post-acute phase of stroke. Methods Adult stroke (n=92) patients were assessed for SWD via overnight polysomnography. The mean age was 52 ± 1 years and mean latency from injury was 117 ± 10 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 cognitive/outcome measures were: Montreal Cognitive Assessment (MoCA), California Verbal Learning Test (CVLT-II), Neuro-QoL and Mayo Portland Adaptability Inventory (MPAI). Results Women had lower AHI (F(1,88)=9.360, p<.01), fewer arousals (F(1,90)=4.53, p<.05), and spent significantly more time in SWS (F(1,90)=11.525, p<.001) than men; however, SWS was reduced in both sexes. SWS made up < 3% of TST in 60% of patients and was not correlated with higher AHI. SWDs negatively impacted subjective quality of life (NeuroQOL). Longer latencies to sleep were associated with increased depression (p<.05) and decreased positive affect (p<.01). Increased sleep efficiency led to improved positive affect (p<.05) and decreases in emotional/behavioral dyscontrol (p<.05). Increased time in REM sleep decreased emotional/behavioral dyscontrol (p<.05), while increasing satisfaction with social roles and activities(p<.01). SWDs also negatively impacted cognitive/outcome scores. Increased TST and sleep efficiency led to higher scores on CVLT-II list B and long delay free recall (p<.05), while higher AHI led to poorer performance on long delay and forced choice recognition trials (p<.01). Additionally, non-REM AHI negatively impacted MPAI adjustment scores (F(1,69)=4.036, p<.05). Conclusion Male stroke patients displayed significantly more arousals and spent less time in SWS than females. For both sexes, better sleep indicated improved quality of life. Sleep measures were correlated with cognitive/outcome measures. Non-REM AHI significantly predicted outcome at discharge from rehabilitation facility. Support
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