Assessment of sleep disorders and their short-term impact on cognitive and psychiatric outcome following ischemic strokes

Abstract Background Sleep disorders are prevalent problems after stroke that can impair optimal stroke rehabilitation and functional recovery and may contribute to recurrent stroke. Post-stroke sleep disorders are risk factors for cognitive impairment, anxiety, and depression. The purpose of this work is to assess the prevalence and common types of sleep disorders which occur with ischemic stroke, as well as the evaluation of the early effect of sleep disorders on cognitive and psychiatric outcomes of patients. Patients and methods This study was carried out on 50 patients suffering from first ever acute ischemic stroke, their age ranged from 45 to 60 years. Each patient was subjected to full medical history taking, neurological examination using National Institutes of Health Stoke Scale (NIHSS), overnight Polysomnography (PSG), and sleep scales including Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness scale (ESS). A psychiatric evaluation was done using the Arabic version of the Mini-International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS). Cognitive functions were estimated by Montreal Cognitive Assessment (MoCA). PSG and all these scales were applied on patients twice; first, within 1 week from the onset of ischemic stroke and second, 3 months after stroke. Results Post-stroke sleep disorders were prevalent and correlated with stroke severity using NIHSS. Excessive daytime sleepiness (EDS) was the most prevalent (78%) type of post-stroke sleep disorder, and it slightly improved after 3 months. The second type was breathing-related sleep disorders (BSD) presented in 74% of patients, and central sleep apnea was the most frequent type. Insomnia existed in 62% of patients due to poor sleep efficiency and decreased sleep quality, and it slightly improved in follow-up. Periodic limb movement disorder (PLMD) was observed in half of the patients and did not improve after 3 months. Sleep disorders affected cognition (low MoCA scale) and correlated with BSD, EDS, and insomnia. Sleep disorders influenced post-stroke depression and correlated with PLMD, EDS, and insomnia. Sleep disorders provoked post-stroke anxiety and correlated with insomnia and PLMD. Conclusion Sleep disorders (sleep–wake cycle disorders, BSD, and PLMD) were highly prevalent after stroke, and they increased the incidence of post-stroke cognitive impairment, depression, and anxiety.