Sleep macrostructure is associated with discharge neurological deficit in acute ischemic stroke

Background: Stroke remains one of the leading causes of mortality and disability all over the world. Sleep plays a major role in neuroplasticity, and sleep disruption is associated with poor stroke outcomes. The aim of our study was to evaluate the association between the parameters of sleep structure, mainly non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, and their ratio, with the neurological recovery after acute ischemic stroke National Institutes of Health Stroke Scale (NIHSS) at discharge. Material and methods: In this analysis of an open, observational, cohort study, we included 76 patients (mean age 64.6 ± 10.9 years) with verified ischemic supratentorial stroke admitted to the Stroke Unit. Upon admission, all patients underwent standard diagnostic and clinical procedures and treatments. They also underwent a full polysomnography in the acute phase of stroke. Neurological status was assessed using the NIHSS at admission, 24 h after admission, and at discharge. Univariate and multivariate linear regression analyses were applied to identify predictors of neurologic outcome (NIHSS) at discharge. ClinicalTrials.gov identifier: NCT05242393. Results: According to the results of the multivariate linear regression analysis, total sleep time, the proportion of NREM stage 2, and the number of sleep cycles independently predicted NIHSS at discharge (p < 0.001 for all models), after adjustment for initial stroke severity, other health issues, and reperfusion therapy. Conclusions: Our study shows that altered sleep macrostructure is associated with greater neurological deficit at discharge in patients with acute supratentorial ischemic stroke.