Objective measures of sleep problems in subacute stroke inpatients independently associated with admission levels and short-term improvements of daily living activities

• Main Authors: Fang-Yu Pai, 白芳瑜
• Other Authors: Ching-Hsiang Lai
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/33414128549761323438

碩士 === 中山醫學大學 === 醫學資訊學系碩士班 === 104 === Background and Purpose—While prevalent sleep-disordered-breathing (SDB) and sleep disturbances found in subacute stroke patients, scarce researches with objectivemeasures of these two sleep problemstogether were found relating to activities of daily living (ADL) levels. We investigated that objective polysomnographic measures of SDB and sleep disturbance are correlated to ADL outcome over inpatients’stroke rehabilitation programs. Methods—123 eligible subjects were retrospectively enrolled with data of socio-demography, medical comorbidities, stroke characteristics, National Institutes of Health Stroke Score (NIHSS), BI scores, and parameters of one night polysomnography study. Results—Of overall 123 eligible patients (61.6±13.1 years, 23.8±3.4 kg/m2, 33% female; 90.5±36.7 days post-stroke; 46.7±25.1 events/hr in apnea-hypopnea index), 103 (92%) were moderate to severe SDB and 24 patients (19.5%, ≥14 days before discharge) had better CPAP adherence. Diverse polysomnographic values were found over total sleep time (259±71 min), sleep efficiency (69.5±19.3%), sleep latency (24.3±30.9 min) and wakefulness after sleep onset (93.1±74.2 min) as well as the percentage proportions of various ultradian sleeps. Admission levels and admission-discharge difference of Barthel Index (BI) scores were 33.8±23.2, and 10.1±9.2, respectively. NIHSS (10.2±5.6) were available in 57 (46%) ischemic patients. On univariate analysis, NIHSS were negatively associated with admission levels and changes of BI scores (p<0.001, =0.002, respectively). On stepwise backward logistic regression testing, while, age (p=0.026) and wakefulness after sleep onset (p<0.001) were both negatively associated (adjusted R2 =0.234) with admission levels of BI score; comorbidity hypertension, sleep latency, percentage-proportion of stage one sleep, and desaturation events ≥4% (p values <0.001, 0.020, 0.001 and 0.046, respectively; adjusted R2 =0.227) were all negatively independently associated with changes of BI scores. Conclusions—Our data support that PSG should be included in recommendation for management of subacute stroke patients. Our speculation that insomnia in subacute stroke individuals exhibit more urgent than SDB, in terms of stroke outcome, possibly alters the therapeutic strategy for these patients with SDB but resistant to CPAP therapy.