Post-stroke insomnia in community-dwelling patients with chronic motor stroke: Physiological evidence and implications for stroke care

Abstract

Questionnaire studies suggest that stroke patients experience sustained problems with sleep and daytime sleepiness, but physiological sleep studies focussing specifically on the chronic phase of stroke are lacking. Here we report for the first time physiological data of sleep and daytime sleepiness obtained through the two gold-standard methods, nocturnal polysomnography and the Multiple Sleep Latency Test. Data from community-dwelling patients with chronic right-hemispheric stroke (>12 months) were compared to sex- and age-matched controls. Behavioural and physiological measures suggested that stroke patients had poorer sleep with longer sleep latencies and lower sleep efficiency. Patients further spent more time awake during the night, and showed greater high-frequency power during nonREM sleep than controls. At the same time the Multiple Sleep Latency Test revealed greater wake efficiency in patients than controls. Importantly these findings were not due to group differences in sleep disordered breathing or periodic limb movements. Post-stroke insomnia is presently not adequately addressed within the care pathway for stroke. A holistic approach to rehabilitation and care provision, that includes targeted sleep interventions, is likely to enhance long-term outcome and quality of live in those living with chronic deficits after stroke.

Figure 1

Top 2 panels shows makers of sleep propensity obtained from the MSLT for patients and controls. The bottom panel shows the error rates obtained in the TAP.

Figure 2

recruitment flow chart.

Figure 3

Lesion overlap obtained from diffusion-weighed images (1.5 T Siemens Avanto) acquired during routine diagnostics in the acute stroke phase. Using SPM8 (http://sourceforge.net/projects/spmtools/) lesions were delineated with MRIcron (http://www.cabiatl.com/mricro/mricron/index.html) and normalized into standard MNI-space (the Z-coordinates are provided). Color bar indicates the number of overlapping lesions.

Figure 4

Flow chart of protocol. Participants arrived at the laboratory in the afternoon of the adaptation night for a full medical check-up and were given dinner at 7 pm. PSG wire-up started thereafter. The montage on the adaptation night included a nasal airflow sensor to determine OSA. This sensor was not used in the experimental night because it is often uncomfortable for participants. In the morning after the adaptation night, participants were given breakfast and asked to return to the laboratory for the experimental night for 6.30, were given dinner and wired up. In the morning after the experimental night, the PSG was removed. Participants were given breakfast before the EEG was wired up for the MSLT starting at 9 am.