Abstract A115: Fragmented Sleep and Delirium Incidence in Older Patients with Ischemic Stroke: A Device-Based Analysis of Sleep Continuity and Outcomes in the Hospital Setting

Introduction: Disruptions to sleep lead to a cascade of health-related consequences, particularly in the hospital environment. We investigated whether compounded burden due to repeated sleep fragmentation was associated with hospital-acquired delirium (HAD) and discharge outcomes among older acute ischemic stroke (AIS) patients. Methods: Sleep activity data were captured using continuous health monitoring devices for AIS patients (aged ≥ 70 years) treated and admitted at a 7-hospital stroke-certified system (Apr 2023 to Jul 2025). Patients were included if they screened negative for delirium upon admission and had 2+ nights of hospital stay. Nightly sleep continuity was defined if 4+ uninterrupted hours of sleep was recorded during nighttime (10PM to 5AM). Overall sleep continuity was aggregated per visit and categorized as high (>75% nights with continuous sleep), moderate (50-75%), or low (<50%). Outcomes included positive screens for HAD (via routine 12-hour assessments) and discharge to skilled nursing or long-term care (SNF/LTAC). For all analyses, only eligible night shifts with reasonable sleep opportunity were considered. Associations between varying degrees of sleep continuity and outcomes were evaluated using multivariable logistic regression (accounting for pertinent stroke features). Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: A total of 1,209 older AIS patients with recorded sleep were analyzed (median age: 78.0 years; 53.8% female; median length of stay: 4.0 days). Low sleep continuity was observed in 57.2% of patients, among whom 17.1% developed HAD (Table 1). Patients with low (vs high) sleep continuity presented with greater frequency of moderate to severe strokes (25.2% vs 15.4%) and higher comorbidity burden (82.9% vs 64.3%). Compared to patients achieving high sleep continuity throughout the duration of their hospital visit, those experiencing low sleep continuity had over 5-fold higher odds of developing HAD (aOR: 5.12, CI: 2.32-13.60) and over 2-fold higher odds of SNF/LTAC discharge (aOR: 2.63, CI: 1.29-5.95) (Figure 1). Odds of HAD remained significant for those even achieving only moderate sleep continuity (aOR: 3.53, CI: 1.45-9.93). Conclusions: Fragmented sleep is strongly associated with increased delirium incidence and discharge to institutionalized care . Interventions aimed at minimizing nighttime disruptions and improving sleep hygiene are warranted to maximize post-stroke recovery.