The Impact of Sleep Disorders on Functional Recovery and Participation Following Stroke: A Systematic Review and Meta-Analysis

Fulk, George; Boyne, Pierce; Hauger, Makenzie; Ghosh, Raktim; Romano, Samantha; Thomas, Jonathan Oen; Slutzky, Amy; Klingman, Karen J.

doi:10.1177/1545968320962501

Cited by 30 publications

(34 citation statements)

References 112 publications

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“… 1 Although there is some evidence for improvements in sleep parameters from the acute to the chronic stage of stroke, 2 , 3 systematic reviews report a high prevalence of sleep disorders, such as insomnia and sleep disordered breathing, after stroke. 4 , 5 Sleep disorders are reported to be more common in stroke survivors compared to normative values or to healthy control groups. 6 Increases in estimated sleep time (per 24 hour period) from pre-stroke to post-stroke have been found to correlate negatively with the ability to engage in activities of daily living at the chronic stage 2 and reduced quality of life has also been demonstrated for stroke survivors reporting insomnia.…”

Section: Introductionmentioning

confidence: 99%

“…Although some research on sleep after stroke focuses on diagnosable sleep disorders, such as sleep disordered breathing, restless leg syndrome and primary insomnia, 5 , 8 there is also research directly comparing between people with chronic stroke and age-matched controls with sleep measures as a continuum rather than categorising participants as having a sleep disorder or not. This is important, as alongside other post-stroke complications, sub-clinical sleep disruption has the potential for debilitating long-term consequences.…”

Section: Introductionmentioning

confidence: 99%

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Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

Fleming

Smejka

Slater

et al. 2021

Neurorehabil Neural Repair

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Background. Stroke survivors commonly complain of difficulty sleeping. Poor sleep is associated with reduced quality of life and more understanding of long-term consequences of stroke on sleep is needed. Objective. The primary aims were to (1) compare sleep measures between chronic stroke survivors and healthy controls and (2) test for a relationship between motor impairment, time since stroke and sleep. Secondary aims were to explore mood and inactivity as potential correlates of sleep and test the correlation between self-reported and objective sleep measures. Methods. Cross-sectional sleep measures were obtained for 69 chronic stroke survivors (mean 65 months post-stroke, 63 years old, 24 female) and 63 healthy controls (mean 61 years old, 27 female). Self-reported sleep was assessed with the sleep condition indicator (SCI) and sleep diary ratings, objective sleep with 7-nights actigraphy and mood with the Hospital Anxiety and Depression Scale. Upper extremity motor impairment was assessed with the Fugl-Meyer assessment. Results. Stroke survivors had significantly poorer SCI score ( P < .001) and higher wake after sleep onset ( P = .005) than controls. Neither motor impairment, nor time since stroke, explained significant variance in sleep measures for the stroke group. For all participants together, greater depression was associated with poorer SCI score ( R2adj = .197, P < .001) and higher age with more fragmented sleep ( R2adj = .108, P < .001). There were weak correlations between nightly sleep ratings and actigraphy sleep measures ( r s = .15–.24). Conclusions. Sleep disturbance is present long-term after stroke. Depressive symptoms may present a modifiable factor which should be investigated alongside techniques to improve sleep in this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

Fleming

Smejka

Slater

et al. 2021

Neurorehabil Neural Repair

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“… 1 Obstructive sleep apnea–hypopnea syndrome (OSAHS) has been recently described as an emerging risk factor for the first and recurrent AIS. 2 Moreover, OSAHS has been associated with worse neurological prognosis and higher mortality in patients with AIS. 2 The relationship between OSAHS and stroke might be partially explained by the presence of common risk factors for both diseases.…”

Section: Introductionmentioning

confidence: 99%

“… 2 Moreover, OSAHS has been associated with worse neurological prognosis and higher mortality in patients with AIS. 2 The relationship between OSAHS and stroke might be partially explained by the presence of common risk factors for both diseases. For example, OSAHS has been proposed as a risk factor for refractory hypertension and high nocturnal blood pressure, 3 both of which also increase the risk of AIS.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of obstructive sleep apnea syndrome in Spain’s Stroke Belt

et al. 2021

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Objective Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain. Methods We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests. Results Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients. Conclusions The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.

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“…Sleep disorders are more common in people with neurologic disorder than in the general population. Sleep disordered breathing (SDB) is a risk factor for stroke and leads to poorer functional recovery in people with stroke 5. SDB is common in people with spinal cord injury (SCI), and over 50% of people with SCI report symptoms of insomnia 6.…”

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confidence: 99%