Abstract 3815: Relationship Between Sleep Duration And Functional Outcomes In Patients With Ischemic Stroke - A New Factor To Think About

Abstract

Introduction: Sleep duration has been associated with an increased risk of mortality, but there is little data on the impact of sleep duration on functional status and health-related quality of life (hrQoL) in the stroke population. We explored the relationship of sleep duration with hr-QoL and functional status in ischemic stroke patients being seen in cerebrovascular outpatient clinics. Methods: The Cleveland Clinic Cerebrovascular Center collects patient-reported and provider collected clinical information in all patients seen in the ambulatory clinic beginning Jan 2009 and included the EuroQol (EQ-5D) (generic hrQOL scale) - the Patient Health Questionnaire 9 PHQ9 (depression screen) and the Stroke Impact Scale 16 (disability scale), NIHSS, and Rankin. Sleep time categories were defined as: short sleep - 9 hours per night, normal sleep - 6-9 hours per night. We analyzed data from the first visits of patients with diagnosis of ischemic stroke seen between Dec 13, 2010 to June 30, 2011. Factors associated with sleep duration were assessed using multinomial regression with sleep duration category serving as the dependent variable. To explore the relationship of sleep duration with functional status, sleep duration was entered as a covariate in linear regression analyses along with demographics, stroke mechanism, days since stroke, marital status and NIHSS score. Results: Mean age of the 1,246 patients was 59.1 yrs (SD 14.6) and 54.6% were female. Black race was associated with short sleep duration (p=.0053). Several factors were associated with long sleep duration including: black race (p<0.0001), single status (0=0.0058), mechanism small vessel occlusions (<0.0001) and cryptogenic embolism (p <0.0001). Short and long sleepers had significantly greater depression severity and lower quality of life compared to those with normal sleep duration, as indicated by higher scores on the PHQ-9 ( 7.0 short, 12.1 long vs 4.3 normal, p<0.0001) , and lower scores on the EQ-5D (0.71 short, 0.65 long, 0.80 normal, p< 0.0001). Similarly, short and long sleepers had higher disability as defined by SIS16 (78.7 short , 70.5 long vs 83.8 normal, p=0.0002) than those in the 6-9 hr rage. This remained significant in the long sleeper group after adjustment for multiple factors. Conclusion: Short and long sleepers have a lower quality of life and higher rates of disability. Sleep duration, especially longer sleep times, may be a relevant factor in outcomes after stroke and merits further evaluation.