Glozier Nick, Moullaali Tom J, Sivertsen Børge, Kim Dukyeon, Mead Gillian, Jan Stephen, Li Qiang, Hackett Maree L
Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.
The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia.
Cerebrovasc Dis Extra. 2017;7(1):9-20. doi: 10.1159/000455751. Epub 2017 Feb 3.
Insomnia symptoms are common in the population and have negative psychosocial and functional sequelae. There are no prospective studies of the course of such symptoms and their impact, if any, in stroke survivors. This prospective cohort study investigated insomnia after stroke in working-age adults and evaluated its impact on psychological and functional outcomes over the subsequent year.
We prospectively recruited 441 young (<65 years) consecutive stroke survivors from 20 public hospitals in the New South Wales Stroke Service network. Participants were assessed by self-report and interview at 28 days, 6 months, and 12 months after stroke. Insomnia was defined using a common epidemiological measure of sleep disturbance and daytime consequences. Depression, anxiety, disability, and return to work were assessed through standardized measures.
The point prevalence of insomnia at each time point in the year after stroke was stable at 30-37% and more common in females. Fifty-eight (16%) of all participants reported "chronic" insomnia, with symptoms at both baseline and 6 months later. At 12 months, this group was more likely to be depressed (OR 6.75, 95% CI 2.78-16.4), anxious (OR 3.31, 95% CI 1.54-7.09), disabled (OR 3.60, 95% CI 2.07-6.25), and not have returned to work, compared to those without insomnia over the same period.
CONCLUSIONS: Chronic insomnia has a negative effect on disability and return to work 1 year after stroke even after adjusting for demographic, psychiatric, and disability factors. Identifying and appropriately targeting insomnia through known effective treatments may improve functional outcomes after stroke. .
失眠症状在人群中很常见，会产生负面的心理社会和功能后遗症。目前尚无关于此类症状的病程及其对中风幸存者影响（如有）的前瞻性研究。这项前瞻性队列研究调查了工作年龄成年人中风后的失眠情况，并评估了其在随后一年对心理和功能结局的影响。
我们从新南威尔士州中风服务网络的20家公立医院前瞻性招募了441名年龄小于65岁的连续中风幸存者。在中风后28天、6个月和12个月通过自我报告和访谈对参与者进行评估。使用常见的睡眠障碍和日间后果流行病学测量方法定义失眠。通过标准化测量评估抑郁、焦虑、残疾和重返工作情况。
中风后一年中每个时间点失眠的时点患病率稳定在30%-37%，且在女性中更为常见。所有参与者中有58人（16%）报告有“慢性”失眠，在基线和6个月后均有症状。在12个月时，与同期无失眠者相比，该组更有可能出现抑郁（比值比6.75，95%置信区间2.78-16.4）、焦虑（比值比3.31，95%置信区间1.54-7.09）、残疾（比值比3.60，95%置信区间2.07-6.25），且未重返工作岗位。
即使在调整了人口统计学、精神疾病和残疾因素后，慢性失眠在中风后1年对残疾和重返工作仍有负面影响。通过已知有效的治疗方法识别并适当针对失眠可能会改善中风后的功能结局。
