Tayade Kamalesh, Vibha Deepti, Singh Rajesh Kumar, Pandit Awadh Kishor, Ramanujam Bhargavi, Das Animesh, Elavarasi Arunmozhimaran, Agarwal Ayush, Srivastava Achal Kumar, Tripathi Manjari
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Front Neurol. 2025 Jul 16;16:1587378. doi: 10.3389/fneur.2025.1587378. eCollection 2025.
Post-stroke sleep disorders (PSSD) are under-reported and under-treated, despite their impact on recovery, quality of life, and post-stroke depression. Although polysomnography (PSG) is the gold standard for diagnosis, its limited availability leads to underdiagnosis.
To assess the prevalence of PSSD based on patient- and caregiver-reported data, and to evaluate their concordance with findings from overnight PSG in post-stroke patients.
In this cross-sectional study, adult patients (aged ≥18 years) with ischemic or hemorrhagic stroke (1 month to 1 year post-onset) were assessed. Sleep-related history was obtained from patients and caregivers. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), risk of obstructive sleep apnea (OSA) was assessed with the STOP-BANG questionnaire, and depression and anxiety were evaluated with the Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), respectively. Stroke severity and outcomes were evaluated using the modified Rankin Scale (mRS) and Stroke-Specific Quality of Life Scale (SS-QoL). A subset underwent overnight PSG using a 14-channel SOMNOmedics system, analyzed per American Academy of Sleep Medicine (AASM) criteria. The Apnea-Hypopnea Index (AHI) was used to quantify sleep-disordered breathing.
Out of 103 enrolled patients, 41 (39.8%) underwent PSG. While only 23.3% (=24) of patients and 11.7% (=12) of caregivers independently reported sleep disturbances after stroke, specific questioning increased detection to 62%. PSG revealed obstructive sleep apnea (OSA) in 62% of those denying sleep issues and in 100% of those self-reporting problems. Periodic limb movement disorder in sleep (PLMS) was present in 34.5% of asymptomatic individuals. Higher STOP-BANG scores and longer stroke duration were seen in the PSG group. Wakefulness after sleep onset (WASO) >120 minutes was more common in patients with PSQI >5. AHI >5 was present in 65.8%, but not associated with any demographic, clinical, or questionnaire-based variables.
There is poor correlation between self/caregiver-reported sleep problems and PSG-confirmed diagnoses in post-stroke patients. Proactive screening using structured questionnaires and PSG (or alternatives such as actigraphy) is essential in resource-limited settings to detect and treat sleep disorders that may impact recovery.
尽管中风后睡眠障碍（PSSD）对恢复、生活质量和中风后抑郁有影响，但报告不足且治疗不足。虽然多导睡眠图（PSG）是诊断的金标准，但其可用性有限导致诊断不足。
根据患者和照顾者报告的数据评估PSSD的患病率，并评估其与中风后患者夜间PSG检查结果的一致性。
在这项横断面研究中，对成年缺血性或出血性中风患者（发病后1个月至1年，年龄≥18岁）进行评估。从患者和照顾者处获取睡眠相关病史。使用匹兹堡睡眠质量指数（PSQI）评估睡眠质量，使用STOP-BANG问卷评估阻塞性睡眠呼吸暂停（OSA）风险，分别使用汉密尔顿抑郁量表（HAM-D）和汉密尔顿焦虑量表（HAM-A）评估抑郁和焦虑。使用改良Rankin量表（mRS）和中风特异性生活质量量表（SS-QoL）评估中风严重程度和结局。一部分患者使用14通道SOMNOmedics系统进行夜间PSG检查，并根据美国睡眠医学学会（AASM）标准进行分析。呼吸暂停低通气指数（AHI）用于量化睡眠呼吸紊乱。
在103名登记患者中，41名（39.8%）接受了PSG检查。虽然只有23.3%（=24）的患者和11.7%（=12）的照顾者独立报告中风后睡眠障碍，但通过特定询问将检测率提高到了62%。PSG显示，在否认有睡眠问题的患者中有62%存在阻塞性睡眠呼吸暂停（OSA），在自我报告有问题的患者中100%存在。34.5%的无症状个体存在睡眠期周期性肢体运动障碍（PLMS）。PSG组的STOP-BANG评分更高，中风持续时间更长。PSQI>5的患者中，睡眠后觉醒（WASO）>120分钟更为常见。65.8%的患者AHI>5，但与任何人口统计学、临床或基于问卷的变量均无关联。
中风后患者自我/照顾者报告的睡眠问题与PSG确诊的诊断之间相关性较差。在资源有限的环境中，使用结构化问卷和PSG（或诸如活动记录仪等替代方法）进行主动筛查对于检测和治疗可能影响恢复的睡眠障碍至关重要。
