Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study

Cierra Williams-Cooke; Elise Watts; Jonathan Bonnett; Mohammed Alshehri; Catherine Siengsukon

doi:10.1016/j.arrct.2021.100150

Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study

Arch Rehabil Res Clin Transl. 2021 Jul 26;3(3):100150. doi: 10.1016/j.arrct.2021.100150. eCollection 2021 Sep.

Authors

Cierra Williams-Cooke¹, Elise Watts², Jonathan Bonnett², Mohammed Alshehri¹, Catherine Siengsukon¹

Affiliations

¹ Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS.
² Rehabilitation Department, St. Luke's Hospital, Kansas City, MO.

Abstract

Objective: To describe the change in sleep duration during inpatient rehabilitation and to determine if sleep quality and sleep duration is associated with functional disability for individuals after stroke. It was hypothesized that participants who experienced optimal sleep during inpatient rehabilitation would have greater functional ability at discharge.

Design: Longitudinal observation study.

Setting: Inpatient rehabilitation unit at a large, urban hospital.

Participants: Thirty-seven individuals with acute stroke (N=37; mean age, 62.5±11.8y, male=20, female=17) were recruited from September 2018 to September 2019. Participants were invited to participate in the study by clinical personnel associated with their usual care as they were admitted to inpatient rehabilitation.

Interventions: Not applicable.

Main outcome measures: Participants were asked to wear an actigraph for the duration of their rehabilitation program to assess sleep. The first 3 nights of actigraphy data were averaged to obtain total sleep time (TST) and sleep efficiency (SE) at admission, and the last 3 nights were averaged for TST and SE at discharge. Functional disability (primary outcome was FIM) at admission and discharge was gathered from the participants' medical records. One-way analysis of variance and chi-square analyses assessed for group differences, and regression modeling was used to determine if sleep was associated with functional ability at discharge.

Results: Sixteen participants (43%) were categorized as "good sleepers" and 21 (57%) were "poor sleepers" based on their TST at admission. Of the poor sleepers, 14 participants (66%) remained short duration sleepers (<7h at admission and discharge). Sleep outcomes did not significantly predict FIM score at discharge.

Conclusions: Most participants had less than optimal sleep duration during inpatient rehabilitation. Efforts may be warranted to optimize sleep during inpatient rehabilitation.

Keywords: ADL, activities of daily living; REM, rapid eye movement; Rehabilitation; SE, sleep efficiency; Sleep; Stroke; TST, total sleep time.