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Published on: April 26, 2024
Joint trajectories of sleep quality and cognitive function after acute ischemic stroke: a prospective cohort study
Li Wang1, Yuhan Cheng2, Sibei Wan2
1Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Background:
Sleep disorders and cognitive impairment commonly co-occur after acute ischemic stroke (AIS), yet their co-development is rarely modeled jointly.
Objective:
To determine whether sleep quality and cognitive function after AIS show asynchronous rather than automatically parallel recovery trajectories during the first year after discharge, and to identify distinct joint trajectory subgroups and baseline factors associated with trajectory membership.
Methods:
In this single-center prospective cohort in Shanghai (December 2023-October 2024), AIS inpatients were assessed within 24 h before discharge (T1) and at 3 (T2) and 12 months (T3). Sleep quality (PSQI; reverse-coded for modeling) and cognition (MoCA) were jointly modeled using group-based dual trajectory modeling (GBDTM). The optimal class solution was selected using information criteria and classification quality. Multinomial logistic regression (C1 reference) examined predictors of class membership. Generalized estimating equations (GEE) evaluated longitudinal changes in NIHSS, Barthel Index, IADL, and PHQ-9 across classes.
Results:
Among 515 participants, a 3-class solution was optimal: C1 sleep improvement-cognitive decline (29.51%, n = 152), C2 sleep decline-cognitive improvement (43.30%, n = 223), and C3 sleep improvement-cognitive improvement (27.18%, n = 140). For C2 (vs C1), widowhood, left-hemisphere infarction, and prior stroke history were associated with lower odds of class membership, whereas arrhythmia, atrial fibrillation, and baseline PSQI (T1) were associated with higher odds of class membership (all p < 0.05). For C3 versus C1, unmarried status was associated with higher odds of C3 membership, whereas left-hemisphere infarction, social medical insurance, and baseline PSQI were associated with lower odds of C3 membership. GEE showed no significant between-class differences in NIHSS, Barthel Index, or IADL at follow-up time points (all p > 0.05); PHQ-9 increased over time and was higher in C3 than C1 at T1 and T2.
Conclusion:
AIS survivors show heterogeneous and sometimes asynchronous joint sleep-cognition trajectories. Joint trajectory stratification and its correlates may inform targeted follow-up and individualized management.
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