Sleep architecture changes and their impact on short-term ischemic stroke functional outcome

Objective. To evaluate the association between the parameters of sleep macrostructure and the short-term post-stroke functional outcome (modified Rankin scale (mRS) at discharge). Material and methods. In this open, observational, cohort study, we enrolled 78 patients with verified acute ischemic stroke admitted to the Stroke Unit within 24 h after symptom onset. All patients underwent standard diagnostic and clinical procedures and treatments. In addition, they underwent a full polysomnography in the acute phase of stroke within 14 days of admission to the hospital. Univariate and multivariate linear regression analyses were applied to define predictors of functional outcome (mRS) at discharge. Results. According to the linear regression model (it explains ≈40% of the variability of mRS at discharge) the following factors appeared to be independent predictors: total sleep time, proportion of NREM stage 2 (NREM N2%), National Institutes of Health Stroke Scale (NIHSS) at 24 hours after admission, and Charlson index (R2=0.398, p<0.001). Each additional hour of sleep was associated with a decrease in mRS by 0.15 points, an increase in the proportion of NREM N2% by 1%, and a decrease in mRS by 0.032 points. Conclusions. Alterations in sleep macrostructure following ischemic stroke, specifically reduced total sleep time and decreased NREM stage 2 percentage, are associated with short-term functional outcomes as measured by the modified Rankin scale (mRS) at discharge. Assessment and management of sleep disorders should be integrated into comprehensive rehabilitation strategies for ischemic stroke.