Circadian activity rhythm and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke

Oliveira, Débora Carvalho de; Ferreira, Paula Regina Cavalcanti; Fernandes, Aline Braga Galvão Silveira; Pacheco, Thaiana Barbosa Ferreira; Avelino, Matheus Madson Lima; Cavalcanti, Fabrícia Azevêdo da Costa; Vieira, Edgar Ramos; Campos, Tânia

doi:10.3233/nre-182665

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…This may be caused by different epidemiological patterns of stroke in different regions. It has been shown that younger age and less likelihood of low physical activity were the characteristics of stroke in Asia, [26,27] which Ho et al, [12] Hongkong Yes Yes Yes Yes Unclear Unclear Yes Yes Unclear Yes No 6 Khazaei et al, [13] Iran Yes Yes Yes Yes Unclear Unclear Yes Yes Unclear Yes No 6 Sonmez et al, [15] Cyprus Yes Yes Yes Yes Unclear Unclear Yes Yes Unclear Yes No 6 Pereira et al, [16] Brazil Yes Yes Yes Yes Unclear Unclear Yes Yes Unclear Yes No 6 Kasai et al, [18] Japan Yes Yes Yes Yes Unclear Unclear Yes Yes Unclear Yes No 6 Zhao et al, [20] China Yes Yes Yes Yes Unclear Unclear Yes Yes Unclear Yes No 6 Nguyen et al, [24] Vietnam Yes Yes Yes Yes Unclear Unclear Yes Yes Unclear Yes No 6 de Oliveira et al, [23] Zhang et al, [14] China 1 1 0 0 2 1 0 1 6 He et al, [19] China 1 1 0 0 2 1 0 1 6 Fan et al, [21] China 1 1 0 1 2 1 1 1 8 Xiao et al, [17] China 1 1 0 0 2 1 0 1 6 Brutto et al, [22] may be related to lower prevalence of poor sleep quality. This was consistent with a previous review regarding the association between physical activity and quality of sleep.…”

Section: Crossmentioning

confidence: 99%

Sleep quality after stroke: A systematic review and meta-analysis

Luo

Liu

et al. 2023

Medicine

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Background: Sleep-related problems are debilitating and long-lasting conditions in individuals with stroke. We aimed to estimate the prevalence of poor sleep quality after stroke by conducting a systematic review and meta-analysis.Methods: Five databases (PubMed, Embase, Web of Science, Scopus, and CINHAL) were searched for literature published before November 2022. Studies recruiting participants with stroke, using a validated scale to measure sleep quality and in English were included. We used the Agency for Healthcare Research and Quality Scale and Newcastle-Ottawa Scale to assess the quality of eligible studies. Pooled prevalence and subgroup analyses were performed to understand the variation in sleep quality among studies. We followed the PRISMA checklist to report the study.Results: Thirteen studies were included for analysis (n = 3886). The pooled prevalence of poor sleep quality was 53% (95% CI 41-65%). Studies using PSQI with a cutoff point of 7 had a prevalence of 49% (95% CI 26-71%), whereas those with a cutoff point of 5 had a higher prevalence of 66% (95% CI 63-69%) (P = .13). Geographical location could explain the prevalence variation between studies. The majority of included studies had a medium level quality of evidence (10/13). Conclusion:Poor sleep quality appears to be common in patients with stroke. Considering its negative impact on health, effective measures should be taken to improve their quality of sleep. Longitudinal studies should be conducted to examine the contributing factors and investigate the mechanisms that lead to poor sleep quality.

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Section: Crossmentioning

confidence: 99%

Sleep quality after stroke: A systematic review and meta-analysis

Luo

Liu

et al. 2023

Medicine

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“…Circadian rhythm disruption is both a risk factor and consequence of stroke. 15 One study 16 found that stroke patients exhibited more fragmented RAR compared to matched non-stroke controls. Preclinical studies have identified mechanisms in which circadian rhythm disruption interferes with key functions in stroke pathophysiology (eg, neurogenesis, angiogenesis, and immune response) and impairs stroke recovery.…”

Section: Introductionmentioning

confidence: 99%

Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study

Lau,

Connor,

Skidmore

2024

Neurorehabil Neural Repair

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Background Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment. Objective To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors. Methods Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition. Results Later onset of rest ( B = 0.45; P = .008) and activity ( B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = −0.42; P = .017; activity onset: B = −0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity ( B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition ( B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition ( B = 0.39; P = .015). Conclusions We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.

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“…19,[21][22][23][24][25][26] In addition, studies have revealed altered circadian and sleep-wake patterns (via RARs) in patients with stroke. [27][28][29] Given that increased risk for dementia, depression, disability, and mortality are wellestablished long-term adverse outcomes in post-stroke survivors, 30,31 understanding the relationship between altered RARs and such post-stroke outcomes is vital for prevention and long-term management.…”

Section: Introductionmentioning

confidence: 99%

Associations of rest-activity rhythm disturbances with stroke risk and post-stroke adverse outcomes

Gao

Zheng

Baker

et al. 2023

Preprint

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Background: Almost all biological and disease processes are influenced by circadian clocks and display ~24-hour rhythms. Disruption of these rhythms may be an important novel risk factor for stroke. We evaluated the association between 24-h rest-activity rhythm measures, stroke risk, and major post-stroke adverse outcomes. <break><break>Methods: In this cohort study, we examined ~100,000 participants in the UK Biobank (44-79 years old; ~57% females) who underwent an actigraphy (6-7 days) and 5-year median follow-up. We derived: (1) most active 10 hours activity counts (M10) across the 24-h cycle and the timing of its midpoint (M10 midpoint); (2) the least active 5 hours counts (L5) and its midpoint timing (L5 midpoint); (3) relative amplitude (RA) - (M10-L5)/(M10+L5); (4) interdaily stability (IS): stability and (5) intradaily variability (IV), fragmentation of the rhythm. Cox proportional hazard models were constructed for time to (i) incident stroke (n=1,652); and (ii) post-stroke adverse outcomes (dementia, depression, disability, or death).<break><break>Results: Suppressed RA (lower M10 and higher L5) was associated with stroke risk after adjusting for demographics; the risk was highest in the lowest quartile [Q1] for RA (HR=1.62; 95% CI:1.36-1.93, p<0.001) compared to the top quartile [Q4]. Participants with later M10 midpoint timing (14:00-15:26, HR=1.26, CI:1.07-1.49, p=0.007) also had a higher risk for stroke than earlier (12:17-13:10) participants. A fragmented rhythm (IV) was also associated with a higher risk for stroke (Q4 vs. Q1; HR=1.27; CI:1.06-1.50, p=0.008), but differences in the stability of rhythms (IS) were not. Suppressed RA was associated with an increased risk of unfavorable post-stroke outcomes (Q1 vs. Q4; 1.78 [1.29-2.47]; p<0.001). All the associations were independent of age, sex, race, obesity, sleep disorders, cardiovascular diseases or risks, and other morbidity burdens.<break><break>Conclusion: Suppressed 24-h rest-activity rhythm may be a risk factor for stroke and an early indicator of major post-stroke adverse outcomes.

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Circadian activity rhythm and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke

Cited by 6 publications

References 27 publications

Sleep quality after stroke: A systematic review and meta-analysis

Sleep quality after stroke: A systematic review and meta-analysis

Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study

Associations of rest-activity rhythm disturbances with stroke risk and post-stroke adverse outcomes

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