Objective Sleep Measures in Subacute Stroke Inpatients Associated with Levels and Improvements in Activities of Daily Living

Publication date: Available online 12 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ren-Jing Huang, Ching-Hsiang Lai, Shin-Da Lee, Fang-Yu Pai, Shen-Wen Chang, Ai-Hui Chung, Yi-Fang Chang, Hua Ting
ObjectiveTo investigate whether objective polysomnographic measures of prevalent sleep problems such as sleep-disordered-breathing (SDB) and insomnia are associated with activities of daily living levels in inpatients at rehabilitation unitsDesignRetrospective and observational studySettingSingle rehabilitation centerParticipantsOne hundred twenty-three enrolled subacute stroke inpatients (61.6 ± 13.1 years; 23.8 ± 3.4 kg/m²; 33% female; 90.5 ± 36.7 days post-stroke) underwent a one-night polysomnography study and one-month-long inpatient rehabilitation program.Main outcome measuresAdmission and discharge Barthel Index (BI) scores and its change scoresResultsOne hundred three (92%) patients had moderate-to-severe SDB (46.7 ± 25.1 events/h in the apnea-hypopnea index), and 24 (19.5%) patients had acceptable continuous positive airway pressure adherence. Diverse values were found for total sleep time (259 ± 71 min), sleep efficiency (69.5 ± 19.3%), sleep latency (24.3 ± 30.9 min), and wakefulness after sleep onset (93.1 ± 74.2 min). Admission BI scores and BI change scores were 33.8 ± 23.2 and 10.1 ± 9.2, respectively. The National Institutes of Health Stroke Score (NIHSS, 10.2 ± 5.6), available in 57 (46%) patients, was negatively associated with admission levels and gains in BI change scores (p <0.001, =0.002, respectively) in a univariate analysis. In regression models with backward selection, excluding NIHSS, both age (p = 0.025) and wakefulness after sleep onset (p <0.001) were negatively associated (adjusted R² = 0.260) with admission BI scores. Comorbidity of hypertension, sleep latency, percentage of stage 1, non-rapid-eye-movement sleep and desaturation events ≥4% (p <0.001, 0.001, 0.021, and 0.043, respectively; adjusted R² = 0.252) were negatively associated with BI score gains.ConclusionsBased on objective sleep measures, insomnia rather than SDB in subacute stroke inpatients was associated negatively with admission levels of activity of daily living and its improvement after a one-month rehabilitation course.



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