Pre-stroke sleep symptoms and neurological outcomes after stroke: an exploratory secondary analysis of two prospective cohorts.
Sleep disturbances before stroke have been associated with stroke risk and severity, but the relationships between habitual pre-stroke sleep symptoms and subsequent neurological and functional outcomes remain unclear. We examined associations between self-reported pre-stroke sleep symptoms and stroke outcomes at admission and follow-up.
This exploratory secondary analysis included data from two prospective stroke cohorts conducted at Copenhagen University Hospital Rigshospitalet, Denmark. Adults with ischaemic stroke or intracerebral haemorrhage who completed a 16-item sleep questionnaire at admission and follow-up were included. Regression models were adjusted for age, sex, previous stroke or transient ischaemic attack, and depression; follow-up models were additionally adjusted for the corresponding admission outcome.
Among 133 participants, the median age was 70 years, 36.8% were women, and 90.2% had ischaemic stroke. Median follow-up was 167 days. Pre-stroke unintended leg movements during sleep, sleep-maintenance insomnia, and nocturia were associated with higher follow-up NIHSS (adjusted β 1.27, 95% confidence interval [CI] 0.41-2.12; β 0.93, 95% CI 0.21-1.66; and β 0.98, 95% CI 0.25-1.72, respectively). Hypnagogic hallucinations were associated with higher admission NIHSS (adjusted β 2.22, 95% CI 0.61-3.83), lower admission BI (adjusted β -17.83, 95% CI -27.98 to -7.69), NIHSS > 4 (adjusted odds ratio 3.06, 95% CI 1.40-6.67), and BI < 80 (adjusted odds ratio 2.18, 95% CI 1.03-4.65).
Several self-reported pre-stroke sleep symptoms were associated with neurological and functional outcomes after stroke. These pre-stroke symptoms may identify vulnerability phenotypes warranting further investigation.
This exploratory secondary analysis included data from two prospective stroke cohorts conducted at Copenhagen University Hospital Rigshospitalet, Denmark. Adults with ischaemic stroke or intracerebral haemorrhage who completed a 16-item sleep questionnaire at admission and follow-up were included. Regression models were adjusted for age, sex, previous stroke or transient ischaemic attack, and depression; follow-up models were additionally adjusted for the corresponding admission outcome.
Among 133 participants, the median age was 70 years, 36.8% were women, and 90.2% had ischaemic stroke. Median follow-up was 167 days. Pre-stroke unintended leg movements during sleep, sleep-maintenance insomnia, and nocturia were associated with higher follow-up NIHSS (adjusted β 1.27, 95% confidence interval [CI] 0.41-2.12; β 0.93, 95% CI 0.21-1.66; and β 0.98, 95% CI 0.25-1.72, respectively). Hypnagogic hallucinations were associated with higher admission NIHSS (adjusted β 2.22, 95% CI 0.61-3.83), lower admission BI (adjusted β -17.83, 95% CI -27.98 to -7.69), NIHSS > 4 (adjusted odds ratio 3.06, 95% CI 1.40-6.67), and BI < 80 (adjusted odds ratio 2.18, 95% CI 1.03-4.65).
Several self-reported pre-stroke sleep symptoms were associated with neurological and functional outcomes after stroke. These pre-stroke symptoms may identify vulnerability phenotypes warranting further investigation.
Authors
Benomar Benomar, Simonsen Simonsen, Iversen Iversen, Jennum Jennum, West West
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