Association of liquid intake with post-stroke depressive and anxiety symptoms in subjects using estazolam: a prospective cohort study

Insomnia is common in ischemic stroke survivors, who are often treated with estazolam (a benzodiazepine agent). Both stroke and long-term estazolam use are major risk factors for post-stroke depressive and anxiety symptoms. This study investigated the association between long-term liquid intake and the risk of these neuropsychiatric manifestations in stroke survivors receiving estazolam, to inform their clinical management. This was a prospective cohort study that enrolled 453 subjects with ischemic stroke and long-term estazolam treatment for post-stroke insomnia. Mean 24-hour liquid intake was measured repeatedly and averaged from 1 to 6 months after stroke. Depressive and anxiety symptoms were assessed at 7 and 12 months after stroke using the HAM‑D‑17, PHQ‑9, HAM‑A, and GAD‑7 scales. Multivariate logistic regression was used for data analyses. Multivariate logistic regression analyses showed that higher long-term 24-hour liquid intake from 1 to 6 months after stroke was significantly associated with a reduced risk of depressive symptoms (HAM‑D‑17 ≥ 7, PHQ‑9 ≥ 5) and anxiety symptoms (HAM‑A ≥ 7, GAD‑7 ≥ 5) at both 7 and 12 months after stroke (all P < 0.05). Graded dose-response analyses demonstrated a dose-response relationship. Sensitivity analyses confirmed the robustness of these findings. Among ischemic stroke survivors receiving estazolam for insomnia, adequate long‑term liquid intake was significantly associated with a lower risk of screening‑positive post‑stroke depressive and anxiety symptoms. Whether liquid‑intake‑targeted strategies could improve mental health outcomes in this population remains to be determined in future interventional studies. Not applicable.