Sleep disturbance and deficits of sustained attention following stroke

ABSTRACT

Objective: To simultaneously investigate the prevalence of and impact that the poststroke complications of daytime sleepiness, poor sleep quality, depression, and fatigue may be having upon deficits of sustained attention, as assessed using the Psychomotor Vigilance Task (PVT). Method: Twenty-two patients with stroke (mean age: 68.23 ± 12.17 years) and 20 healthy control participants (mean age: 68.1 ± 9.5 years) completed subjective measures of daytime sleepiness, sleep quality, fatigue, and depression and an objective measure of sustained attention as assessed using the PVT. Results: Patients with stroke compared to controls showed heightened levels of fatigue (p = .001, η² = .29) and depression (p = .002, η² = .23), plus greater deficits of sustained attention as reflected by poorer performance across all PVT outcome measures including: slower mean reaction times (p = .002, η² = .22); increased number of lapses (p = .002, η² = .24); and greater variability in reaction time (RT) responses (p = .016, η² = .15). Reaction time distribution analysis suggested that daytime sleepiness and sleep quality had little influence across PVT performance; however, depressive symptomology was associated with longer RT responses, indicative of inattention, and fatigue impacted upon the entire distribution of PVT responses. Conclusions: PVT performance illustrated significant deficits across the domain of sustained attention for patients with stroke in comparison to healthy controls, in terms of inattention as well as slower sensory–motor speed. The common poststroke complications of depressive symptomology and fatigue appear to be associated with these deficits in sustained attention, warranting further investigation.

KEYWORDS:

• Attention
• Depression
• Fatigue
• Sleep
• Stroke

Acknowledgements

The authors wish to thank the Monash Health staff in North-West 2 ward at Kingston Centre for assistance with participant recruitment. In addition, we extend our gratitude to Holly McManus, Anna Scovelle, and Anna Makary for their assistance in participant recruitment and/or data collection.

Additional information

Funding

S.C.P. reports no conflicts of interest. P.W.N. and R.S. report no conflicts of interest relevant for this work. While C.A. reports no conflicts of interest with data as described in this manuscript, in the interest of full disclosure C.A. reports receiving a research award/prize from Sanofi-Aventis; research support from VicRoads; lecturing fees from Brown Medical School/Rhode Island Hospital and Ausmed; and contract research funding from Pacific Brands through an agreement between Monash University and Pacific Brands. In addition, she has served as consultant to the Rail, Bus and Tram Union, the National Transport Commission, and the Transport Accident Commission on issues related to fatigue in transportation, and has served as an expert witness on sleep-related motor vehicle crashes to VicPolice. Clare Anderson is a theme leader within the Cooperative Research Centre for Alertness, Safety and Productivity, which involves working with a consortium of industry, academic, and government partners.