Sindorf Jacob, Campagnini Silvia, O'Brien Megan K, Sunderrajan Aashna, Knutson Kristen L, Zee Phyllis C, Wolfe Lisa, Arora Vineet M, Jayaraman Arun
Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA.
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
Neurorehabil Neural Repair. 2025 Jul;39(7):529-541. doi: 10.1177/15459683251335332. Epub 2025 May 6.
BackgroundOur understanding of sleep during early stroke care and its impact on rehabilitation outcomes remains limited. The objectives of this work were to (1) evaluate multidimensional sleep health and disruptions during acute inpatient rehabilitation for individuals with stroke, and (2) explore the relationship between sleep health/disruptions and functional recovery.MethodsData from 103 individuals with stroke were analyzed during acute inpatient rehabilitation. Sleep health/disruptions were assessed via patient reports, actigraphy, and biometric sensors. Functional outcomes were measured at admission and discharge. Generalized Linear Models (GLMs) were used to describe changes in sleep health over time, and multivariate regressions analyzed sleep disruptions and sleep-related predictors of functional recovery.ResultsOver inpatient stays, sleep improved with a 23% reduction in wake after sleep onset and 15% fewer multiple overnight disruptions. GLMs revealed that improved sleep quality was associated with reduced overnight activity and increased heart rate over time. Poor initial sleep quality and cognitive status were associated with more overnight disruptions. Lastly, minimal associations were found between sleep health and functional recovery.ConclusionsSleep health during inpatient stroke rehabilitation is generally poor, though improves over time. Sleep is affected by neurological recovery and hospital environment. Overnight activity and autonomic biomarkers were associated with perceived sleep health, and both physiological and environmental factors triggered disruptions. The association between functional recovery and indirect indicators of sleep health requires further investigation. These findings reveal new insights about inpatient sleep which can inform early, targeted sleep interventions to optimize post-stroke outcomes.SIESTA, ClinicalTrials.gov (NCT04254484).
背景
我们对早期卒中护理期间睡眠及其对康复结局影响的理解仍然有限。本研究的目的是：（1）评估卒中患者急性住院康复期间的多维睡眠健康状况和睡眠中断情况；（2）探讨睡眠健康/睡眠中断与功能恢复之间的关系。
方法
对103例卒中患者急性住院康复期间的数据进行分析。通过患者报告、活动记录仪和生物传感器评估睡眠健康/睡眠中断情况。在入院和出院时测量功能结局。使用广义线性模型（GLM）描述睡眠健康随时间的变化，并通过多元回归分析睡眠中断情况以及功能恢复的睡眠相关预测因素。
结果
在住院期间，睡眠有所改善，睡眠开始后的觉醒时间减少了23%，夜间多次睡眠中断减少了15%。GLM显示，睡眠质量改善与夜间活动减少以及随时间心率增加有关。初始睡眠质量差和认知状态与更多的夜间睡眠中断有关。最后，睡眠健康与功能恢复之间的关联极小。
结论
卒中住院康复期间的睡眠健康总体较差，但会随时间改善。睡眠受神经恢复和医院环境影响。夜间活动和自主生物标志物与感知到的睡眠健康有关，生理和环境因素都会引发睡眠中断。功能恢复与睡眠健康间接指标之间的关联需要进一步研究。这些发现揭示了关于住院睡眠的新见解，可为早期、有针对性的睡眠干预提供参考，以优化卒中后结局。
SIESTA，ClinicalTrials.gov（NCT04254484）
