Effect of insomnia after acute ischemic stroke on cerebrovascular reactivity: a prospective clinical study in China

Abstract

ObjectiveTo evaluate the effect of insomnia after acute ischemic stroke on cerebrovascular reactivity (CVR). MethodsA total of 158 eligible patients with acute ischemic stroke were enrolled prospectively. Of these, six patients were lost to follow-up, and 152 were included in the final analysis. The patients were divided into the insomnia (N = 24) and non-insomnia (N = 128) groups based on the Athens Insomnia Scale. The insomnia group was further divided into benzodiazepine (BDZ) and non-BDZ treatment groups according to BDZ use status after ischemic stroke. The transcranial doppler ultrasound (TCD) breath-holding test was performed to calculate the breath-holding index (BHI) of the responsible cerebral middle artery, which was used to evaluate CVR. Then, univariate and multivariate linear regression analyses were carried out to determine the effect of insomnia after acute ischemic stroke on CVR. ResultsAt one month after the onset of acute ischemic stroke, TCD-BHI was significantly higher in the non-insomnia group compared with the insomnia group (p = 0.027). In patients with insomnia, TCD-BHI was significantly higher in the BDZ treatment group compared with non-BDZ treatment group (p = 0.039). With age, hypertension, diabetes, hyperlipidemia, long-term smoking, blood homocysteine, and Athens Insomnia Scale score as independent variables, and TCD-BHI at one month after onset as a dependent variable, univariate and multivariate linear regression analyses indicated that the Athens Insomnia Scale score was an independent factor affecting TCD-BHI (regression coefficient, −0.013; 95% confidence interval (CI) −0.024 to −0.003). ConclusionInsomnia after acute ischemic stroke is an independent risk factor for CVR.