Impact of Persistent Poor Sleep Quality on Post-Stroke Anxiety and Depression: A National Prospective Clinical Registry Study

Abstract

Purpose

The impact of poor sleep quality after stroke, especially persistent poor sleep quality, on poststroke anxiety and depression is unclear. We seek to investigate the impact of baseline and persistent poor sleep quality on short-term poststroke anxiety and depression.

Patients and Methods

Data were analyzed for 1619 patients with acute ischemic stroke from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients study (ICONS). The sleep quality was assessed at 2 weeks and 3 months using the Pittsburgh Sleep Quality Index scale (PSQI). Poor sleep quality was defined as a PSQI score of >5, and persistent poor sleep quality was defined as a PSQI score of >5 at each time point. Patients were divided into three groups according to the quality of sleep: good sleep quality, baseline poor sleep quality and persistent poor sleep quality. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 scale (GAD-7), and Modified Rankin Scale (mRS) at 3 months after stroke were taken as the study outcomes.

Results

Persistent poor sleep quality was present in 70.2% of patients after stroke. Compared to those with good sleep quality, patients with baseline poor sleep quality did not show significant differences in disability, anxiety and depression. However, patients with persistent poor sleep were at increased risk of depression (odds ratio, OR 3.04, 95% confidence interval, CI 1.66–5.57, P < 0.01) and anxiety (OR 3.20, 95% CI 1.42–7.19, P < 0.01) at 3 months after stroke. Persistent poor sleep quality was not identified as a risk factor for functional disability at 3 months.

Conclusion

Patients with persistent poor sleep quality are at added risks for depression and anxiety after stroke.

Keywords:

• sleep quality
• depression
• anxiety
• ischemic stroke

Acknowledgments

We gratefully acknowledge the clinicians and patients from the 40 centers involved in this project for their help and support.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest related to this study.

Additional information

Funding

This work was supported by grants from the National Key Research and Development Program of China (2020YFC2005300), Talents Project of Beijing (2018000021469G235), Dongcheng District Talents Project of Beijing (DCQYYRC-789-01-DR), Youth Research Funding, Beijing Tiantan Hospital, Capital Medical University (2018-YQN-18) and Beijing Key Clinical Specialty Program.