Is post-ischemic stroke insomnia related to a negative functional and cognitive outcome?

Our study examined the association between insomnia, and cognitive as well as functional outcomes in a cohort of ischemic stroke patients. We evaluated which stroke features were associated with the development of post-stroke insomnia and how it might affect stroke prognosis.

157 ischemic stroke patients were retrospectively evaluated during their hospitalization in a Portuguese Stroke Unit and re-assessed two years afterwards, at a follow up appointment. We collected data including clinical variables, vascular risk factors, insomnia developed after stroke, use of psychotropic drugs, further sleep studies, specific measures of cognitive function, severity of stroke, and functional performance.

Mean age of study participants was 69.54 ± 12.71 years and 48.4% were male. Post stroke insomnia was diagnosed in 45/157 (28.6%) of patients. Compared to those subjects with no evidence of insomnia, insomnia was associated with worse neurological severity, lower functional independence and higher disability scores at admission and follow up. Male gender (p = 0.006) and previous minor vascular events (p = 0.013) were significantly associated with the development of insomnia after ischemic stroke. There were no significant differences between development of insomnia in patients suffering from anterior circulation stroke when compared with those of the posterior circulation.

Insomnia may have a negative influence on neurological recovery from ischemic stroke, and it seems to associate with worse functional and cognitive outcome of these patients. Screening and appropriate management of post-stroke insomnia should become part of the therapeutic strategy to optimize outcomes of this potentially devastating disease.