Abstract TP379: Excessive Daytime Sleepiness in Stroke Survivors: Evidence From an Integrative Literature Review

Abstract

Background and Purpose: Excessive daytime sleepiness (EDS) is a prevalent symptom among stroke survivors. An understanding and accurate diagnosis of EDS is important, not only because EDS has been identified as an independent risk factor for stroke, but also because EDS may reduce stroke survivors’ quality of life, cognitive functioning and daytime functional performance. The lack of a universally accepted definition of EDS makes it difficult to measure and synthesize research. The purpose of this integrative review is to describe post-stroke EDS; to ascertain conceptual and operational definitions of EDS; to identify factors that contribute to EDS in stroke survivors; and to explore consequences of EDS in stroke survivors. Methods: Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an integrative review of the literature was conducted. We searched the following databases: PubMed, MEDLINE (OvidSP 1946 - April, Week 2, 2015), Embase (OvidSP 1974 - March, Week 1, 2015) and PsycINFO (OvidSP 1967 - April, Week 2, 2015), which yielded 340 articles and 27 articles met inclusion criteria. Results: The evidence suggests EDS is a multidimensional construct that is operationalized with subjective and objective measures. Choosing measures that can quantify both the objective and subjective components is useful to gain a comprehensive understanding of EDS. The antecedents of EDS are sub-types of stroke, sleep disordered breathing, Reversed Robin Hood Syndrome and depression. Consequences of EDS in stroke are serious and negative. A potential framework of post-stroke EDS is proposed and may be of use in clinical practice and in research to identify valid quantifying methods for EDS as well as to prevent harmful outcomes in stroke survivors. Conclusion: EDS is frequently experienced after stroke and may not always be caused by SDB. Healthcare providers and sleep specialists can seek to influence stroke survivors’ functional, neurological, and health-related outcomes through interventions that avoid EDS, depressive symptoms or SDB. Whenever SDB is suspected in stroke survivors, choosing both a subjective and objective evaluation of sleep may be indicated.