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The prevalence and clinical significance of sleep disorders in acute ischemic stroke patients—a questionnaire study

  • Epidemiology • Original Article
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Abstract

Purpose

Sleep disturbances are frequently reported in stroke patients and associated with the outcome of strokes. Using sleep questionnaires, we investigated the prevalence of classified sleep disturbance and the influence of sleep disorders upon a stroke prognosis.

Methods

Patients with acute ischemic strokes or transient ischemic attacks (TIA) were included. We investigated the prevalence of sleep disturbance and the association of outcomes resulting from strokes. The National Institutes of Health Stroke Scale score at day 7 (NIHSS-7) and modified Rankin Scale score at month 3 (mRS-3) stood for short- and long-term outcomes. A series of questionnaires including all Korean versions of the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), Epworth Sleepiness Scale (ESS-K), Berlin Questionnaire, Sleep Obstructive apnea score optimized for Stroke (SOS), Beck Depression Inventory-2, and Hospital Anxiety and Depression Scale were used.

Results

A total of 241 (mean age was 64.2 ± 11.9, 146 males; 60.6%) consecutive acute ischemic stroke patients, including 36 TIAs, were enrolled. The NIHSS score at admission, NIHSS-7, and mRS-3 were 3.26 ± 3.64, 1.72 ± 2.29, and 0.21 ± 0.82, respectively. PSQI-K ≥8.5 was reported in 79 subjects (32.8%), ISI-K ≥15.5 in 29 (12.0%), ESS-K ≥11 in 21 (8.7%), and SOS ≥11 in 48 (20.3%). The NIHSS-7 was associated with the SOS (standardized β = 0.281, p < 0.001) and the mRS-3 with the ISI-K (standardized β = 0.219, p = 0.001) and the SOS (standardized β = 0.171, p = 0.011).

Conclusions

Screening for and intervening in the sleep problems of stroke patients could improve their outcome. As sleep disturbances are associated with short-term and/or long-term outcomes of strokes, active screening and intervention for sleep disturbances after strokes are needed.

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Abbreviations

PSSD:

Post-stroke sleep disorder

TIA:

Transient ischemic attack

SDB:

Sleep-disordered breathing

RLS:

Restless legs syndrome

PSG:

Polysomnography

NIHSS:

National Institutes of Health Stroke Scale

NIHSS-0:

National Institutes of Health Stroke Scale score at day 0

NIHSS-7:

National Institutes of Health Stroke Scale score at day 7

mRS-3:

Modified Rankin Scale at month 3

PSQI:

Pittsburgh Sleep Quality Index

ISI:

Insomnia Severity Index

ESS:

Epworth Sleepiness Scale

BQ:

Berlin Questionnaire

OSA:

Obstructive sleep apnea

SOS:

Sleep Obstructive apnea score optimized for Stroke

BDI-2:

Beck Depression Inventory-2

HADS-D:

Hospital Anxiety and Depression Scale for depression

-K:

Korean version of

SD:

Standard deviation

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Authors and Affiliations

  1. Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu, 41931, South Korea

    Keun Tae Kim, Hye-Jin Moon, Jun-Gyu Yang, Sung-II Sohn, Jeong-Ho Hong & Yong Won Cho

Authors
  1. Keun Tae Kim
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  2. Hye-Jin Moon
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  3. Jun-Gyu Yang
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  4. Sung-II Sohn
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  5. Jeong-Ho Hong
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  6. Yong Won Cho
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Corresponding author

Correspondence to Yong Won Cho.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No.2014R1A5A2010008).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Keun Tae Kim and Hye-Jin Moon contributed equally to the manuscript as first authors in this study.

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Kim, K.T., Moon, HJ., Yang, JG. et al. The prevalence and clinical significance of sleep disorders in acute ischemic stroke patients—a questionnaire study. Sleep Breath 21, 759–765 (2017). https://doi.org/10.1007/s11325-016-1454-5

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  • DOI: https://doi.org/10.1007/s11325-016-1454-5

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