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

Abstract Objective To 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 units. Design Retrospective and observational study. Setting Single rehabilitation center. Participants Inpatients with subacute stroke (N=123) (61.6±13.1 years; 23.8±3.4 kg/m 2 ; 33% women; 90.5±36.7 days post-stroke) underwent a 1-night polysomnographic study and a 1-month inpatient rehabilitation program. Main outcome measures Admission and discharge Barthel Index (BI) scores and its change scores. Results One 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 the BI change scores were 33.8±23.2 and 10.1±9.2, respectively. The National Institutes of Health Stroke Scale (NIHSS, 10.2±5.6), available in 57 (46%) patients, was negatively associated with admission levels and gains in BI change scores (P P =.025) and wakefulness after sleep onset ( P R 2 =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 R 2 =0.252) were negatively associated with BI score gains. Conclusions Based on objective sleep measures, insomnia rather than SDB in inpatients with subacute stroke was associated negatively with admission levels of activity of daily living and its improvement after a 1-month rehabilitation course.