Abstract TMP47: Sleep and Endocrine Disturbances Are Associated With Poorer Outcomes During the Post-Acute Phase of Stroke Recovery

Abstract

Introduction: Sleep disturbances, including decreases in slow wave sleep (SWS) are common following stroke. In this study, we sought to identify the implications of decreased slow wave sleep on endocrine function and cognitive/outcome measures in the post-acute phase of stroke recovery. Methods: Adult stroke patients (n=44) were assessed via overnight polysomnography (PSG). The mean age was 50 ± 1.8 years and mean latency from stroke was 126 ± 16 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. Hormone levels were analyzed within 10 days of PSG. The primary outcome measures were as follows: California Verbal Learning Test (CVLT), Montreal Cognitive Assessment (MoCA), Trails A and B, Mayo Portland Adaptability Inventory (MPAI), and NeuroQOL. Sex differences were also analyzed. Results: Age and BMI were positively correlated with subjective daytime sleepiness using the Epworth Sleepiness Scale (p<.05); however, while BMI was positively correlated with the arousal index (p<.01), it was not correlated with AHI. TST was negatively correlated with subscales of the MPAI (p<.05). Time spent in SWS was associated with decreases in self reported anxiety, fatigue, and sleep disturbances on the NeuroQOL (p<.01). Increases in SWS were also correlated with higher scores on the MoCA (p<.05). Increases in sex hormone binding globulin (SHBG) were associated with decreases in TST (p<.05) and increased percent WASO (p<.01). Additionally, SHBG was negatively associated with the CVLT list B (p<.05). For men, SHBG is positively associated with the number of repetitions on the CVLT (p<.01). As expected, men had a higher arousal index and higher AHI than women. Conclusion: Time spent in SWS is associated with better subjective well-being and improved performance on cognitive measures. Hormone levels, especially SHBG, may serve as early biomarkers for sleep disturbances after stroke and are associated with negative performance on some measures of cognition.