Impact of site, size and severity of ischemic cerebrovascular stroke on sleep in a sample of Egyptian patients a polysomnographic study

Abstract

Background

Sleep difficulties following a cerebrovascular stroke are an interesting topic in the scientific community. Following a brain ischemic insult, a variety of sleep problems can occur.

Aim of work

To study the sleep architecture following stroke and to identify the impact of site, size and severity of ischemic cerebrovascular troke on sleep microstructure.

Subjects and methods

this was a case control study; polysomnogram was done for 93 patients admitted to the stroke unit at El- Hadara university hospital with the first ever ischemic stroke. NIHSS was calculated immediately and 1 month after stroke onset. 50 age matched control subjects with no evidence of central nervous system or major psychiatric disorder by history or clinical examination.

Results

Total sleep time, sleep efficiency were lower in ischemic cerebrovascular stroke patients than in control group and this was statistically significant (p = .001* p = .0001* respectively). Arousal index limb movement index and snoring index were all higher among the ischemic cerebrovascular stroke group in comparison to the control group and this was statistically significant (p = .0001*p = .05*p = .0001). Both the REM(rapid eye movement) and REM latency were highest among brain stem stroke, and this was statistically significant p = .043*, p = .0.001*.cortical infarcts showed higher AHI (apnea hypopnea index)and this was statistically significant p = 0.002* Limb movement index was higher among sizable size stroke and this was statistically significant (p = 0.038). NIHSS National Institutes of Health Stroke Scale after 1 month follow up showed a significant indirect correlation with the lowest oxygen saturation during sleep (p = 0.047). Lowest oxygen saturation was lowest among sizable stokes and desaturation index was highest among sizable size strokes both were statistically significant p = 0.006. NIHSS2 had a significant negative correlation with the lowest oxygen saturation during sleep p = 0.047.

Conclusion

The microstructure of sleep is significantly impacted by cerebrovascular stroke. Brain stem strokes had the highest REM and REM latency, while cortical strokes had the highest moderate-to-severe AHI. Sizable strokes displayed increased indices of limb movement, desaturation, and oxygen saturation.