Abstract P68: Disrupted Electrophysiological Sleep in Critically ill Stroke Patients: Does it Matter?

Abstract

Mounting evidence suggest that poor sleep quality may impact outcome following stroke. While sleep disturbances are common among critically ill patients, little is known about sleep characteristics in neurocritical stroke patients. We examined sleep characteristics in acute stroke patients admitted to an intensive care unit (ICU) compared to those admitted for non-stroke conditions. Methods: Retrospective analysis of critically ill patients who underwent continuous electroencephalographic (cEEG) monitoring in the ICU from 2018-19. Sleep was scored based on American Academy of Sleep Medicine-defined EEG criteria. EEG and clinical characteristics [NIH Stroke Scale (NIHSS), Hunt and Hess (HH) Grade, and ICH Score] were collected. Primary outcomes were based on modified Rankin Scale (mRS) scores of which 2 or less was considered favorable. Differences were assessed using Chi-Square test. Results: 228 ICU patients underwent cEEG; mean age was 58 years (range 18-91) and 57% were male. 61 (27%) were admitted for acute stroke (16 ischemic, 17 aneurysmal subarachnoid hemorrhage (aSAH), 27 non-traumatic intracerebral hemorrhage (ICH)). The other 167 critically ill patients were admitted for medical, surgical, or non-stroke related neurological conditions. In those with stroke, mean NIHSS scores for ischemia, mean ICH Score for ICH, and mean HH for aSAH were 18.78, 2.12, and 3.36, respectively. Rates of attaining any sleep were similar between stroke (27.9%) and non-stroke patients (26.9%). 29.4% of stroke patients who achieved sleep had good outcomes compared to only 9.1% that did not (χ 2 (1)=2.79, p=0.095). In stroke patients that achieved sleep, 52.9% of patients reached Stage N1, 47.1% Stage N2 and none reached Stages N3 or REM. In the non-stroke cohort, 46.6% who achieved sleep had good outcomes compared to 26.2% who did not (χ 2 (1)=6.34, p=0.012). Of these, 37.8% reached Stage N1 sleep, 60% Stage N2, 2.22% Stage N3, and none reached Stage REM. Discussion: Critically ill stroke and non-stroke patients have disrupted electrophysiological sleep, and none reach REM stage. A trend towards improved outcome in stroke survivors was observed in those who slept. The association between sleep variability, stroke mechanism, and functional outcome needs further exploration.