Pre-stroke sleep symptoms and neurological outcomes after stroke: an exploratory secondary analysis of two...

Sleep disturbances before stroke have been associated with stroke risk and severity, but the relationships between habitual pre-stroke sleep symptoms and subsequent neurological and functional outcomes remain unclear. We examined associations between self-reported pre-stroke sleep symptoms and stroke outcomes at admission and follow-up.

This exploratory secondary analysis included data from two prospective stroke cohorts conducted at Copenhagen University Hospital Rigshospitalet, Denmark. Adults with ischaemic stroke or intracerebral haemorrhage who completed a 16-item sleep questionnaire at admission and follow-up were included. Regression models were adjusted for age, sex, previous stroke or transient ischaemic attack, and depression; follow-up models were additionally adjusted for the corresponding admission outcome.

Among 133 participants, the median age was 70 years, 36.8% were women, and 90.2% had ischaemic stroke. Median follow-up was 167 days. Pre-stroke unintended leg movements during sleep, sleep-maintenance insomnia, and nocturia were associated with higher follow-up NIHSS (adjusted β 1.27, 95% confidence interval [CI] 0.41-2.12; β 0.93, 95% CI 0.21-1.66; and β 0.98, 95% CI 0.25-1.72, respectively). Hypnagogic hallucinations were associated with higher admission NIHSS (adjusted β 2.22, 95% CI 0.61-3.83), lower admission BI (adjusted β -17.83, 95% CI -27.98 to -7.69), NIHSS > 4 (adjusted odds ratio 3.06, 95% CI 1.40-6.67), and BI < 80 (adjusted odds ratio 2.18, 95% CI 1.03-4.65).

Several self-reported pre-stroke sleep symptoms were associated with neurological and functional outcomes after stroke. These pre-stroke symptoms may identify vulnerability phenotypes warranting further investigation.