Abstract DP141: Impact of Inpatient Sleep on Functional Outcomes in Acute Ischemic Stroke Patients

Introduction: Sleep facilitates reorganization of neural circuits, synaptic strengthening, clearance of neurotoxins, and reduction of neuroinflammation. In the post-stroke setting, symptoms of poor sleep and insomnia are associated with an increased risk of recurrent cerebrovascular events. However, there is a paucity of data examining the role of inpatient hospital sleep in the post-stroke setting. In this study, we analyzed inpatient sleep quantity in acute ischemic stroke (AIS) patients and compared functional outcomes at 90 days between cohorts with different mean lengths of sleep time during hospitalization. Methods: A retrospective review of AIS patients at a comprehensive stroke center, hospitalized within 24-48 hours of symptom onset between July 2023 – September 2024 was conducted using institutional registries. Inpatient sleep data was acquired using BioButtons. ® Two groups were defined by stratifying the mean total night sleep duration to less than 6 hours and greater than 6 hours. Exclusion criteria included baseline modified Rankin score (mRS) > 4, pre-existing neurodegenerative conditions (Parkinson’s and Alzheimer’s disease), and pre-existing sleep disorders (obstructive sleep apnea, narcolepsy, and severe insomnia). The primary functional outcome was mRS at 90 days. Secondary outcomes were symptomatic intracerebral hemorrhage (sICH), length of hospital stay, and mortality, adjusting for confounders. Statistical analysis methods included Wilcoxon Rank Sum, Chi Squared, and Fisher’s Exact Testing. Results: A total of 536 patients were included, with mean age +/- SD: 68.8 ± 14.8 years, 49.3% female. Stratified analysis by mean nightly sleep duration detected mRS 0-2 in 65.4% of patients with greater than 6 hours of sleep, compared to 52.7% of those with less than 6 hours (p = 0.022). The mean length of hospital stay (SD) was 7.3 (7.7) days in the greater than 6 hours of sleep group and 8.5 (9.6) in the less than 6 hours group (p = 0.047). Co-morbidities of myocardial infarction, hypertension and atrial fibrillation were significantly higher in patients with less than 6 hours of sleep (p < 0.001). There was no significant difference in incidence of sICH and mortality. Conclusion: Increased inpatient sleep is associated with improved functional outcome at 90 days, and decreased length of hospital stay in acute ischemic stroke patients in a single comprehensive stroke center. Further studies will determine the generalizability of these findings.