Association Between Self And Caregiver Reported Sleep Problems And Polysomnographic Findings In Post-stroke Patients: A Cross Sectional Study.
Kamalesh Tayade1, Deepti Vibha1, Manjari Tripathi1, Rajesh Kumar Singh1, Arunmozhimaran Elavarasi1
1Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
Objective:

To determine post-stroke sleep disturbances (PSSD) by polysomnography (PSG) and compare them with patient and caregiver reported symptoms and sleep questionnaires 

Background:
Post stroke sleep disturbances (PSSD) are common with prevalence of 70-80%. The awareness of patients and caregivers about the various sleep problems and its implications on quality of life & outcome has not studied extensively. Identification can aid in optimum management and rehabilitation of post-stroke patients.
Design/Methods:

In a cross-sectional study, we screened post-stroke patients (between one month to one year after stroke onset) & their caregivers about various sleep problems. This was done by a screening questionnaire, followed by specific sleep questionnaires (Pittsburgh sleep quality index (PSQI) and STOP BANG questionnaire). A subset of consenting patients underwent overnight PSG. The association of sleep questionnaires with PSG findings were done.  

Results:

In the study period (January 2021 and June 2022), 103 post-stroke patients were enrolled, of which 41(39.8%) underwent PSG.  While only 15.5% (16/103) patients and/or caregivers reported any sleep disorders themselves, when specifically asked about insomnia, snoring, excessive daytime sleepiness & abnormal leg movements in sleep, this number increased to 60.2% (60/103). Further, a PSQI>5, signifying poor sleep quality was present in 71.8% (74/103), and high risk of obstructive sleep apnea (OSA) by STOP BANG questionnaire was present in 33% (34/103). PSG showed Apnea Hypopnea Index (AHI)>5 in 65.9% (27/41) patients, 39% (16/41) had periodic leg movements (PLMS) and 34.2% (14/41) had disrupted sleep. Even when patients & caregivers had denied any sleep disturbances, the PSG in 29 such patients showed OSA in 62 % (18/29) and PLMS in 34.5% (10/29). 

Conclusions:

The study provided insight into the knowledge gap between patient & caregiver perceived sleep disturbances & sleep questionnaires and polysomnography. Longitudinal studies are warranted in this population to assess the effect of treatment of sleep disturbances on outcomes like quality of life and stroke recurrence.

10.1212/WNL.0000000000202666