Association Between Pre-Stroke Subjective Sleep Status and Post-Stroke Cognitive Impairment: A Nationwide Multi-Center Prospective Registry

Jia-Li Zhang; An-Xin Wang; Yang Yang; Qin Xu; Xiao-Ling Liao; Wei-Guo Ma; Ning Zhang; Chun-Xue Wang; Yong-Jun Wang

doi:10.2147/NSS.S378743

Association Between Pre-Stroke Subjective Sleep Status and Post-Stroke Cognitive Impairment: A Nationwide Multi-Center Prospective Registry

Nat Sci Sleep. 2022 Nov 2:14:1977-1988. doi: 10.2147/NSS.S378743. eCollection 2022.

Authors

Jia-Li Zhang^#^{1

2}, An-Xin Wang^#^{1

2}, Yang Yang^{2

3}, Qin Xu^{1

2}, Xiao-Ling Liao^{1

2}, Wei-Guo Ma⁴, Ning Zhang^{2

3}, Chun-Xue Wang^{2

3

5}, Yong-Jun Wang^{1

2}

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
² China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
³ Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
⁴ Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
⁵ Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Background: Although sleep disorders significantly increase the risk of cognitive impairment, literature is relatively scarce regarding the impact of sleep status on cognitive function in patients with acute ischemic stroke (AIS). We seek to study the association between pre-stroke subjective sleep status and cognitive function at 3 months after stroke.

Patients and methods: Data were analyzed for 1,759 AIS patients from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients Study (ICONS). Pre-stroke subjective sleep status was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Greater sleep fragmentation was defined as waking up in the middle of the night or early morning ≥3 times a week. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) at 3 months after stroke. Primary endpoint was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after stroke. The association between subjective sleep status and PSCI was evaluated using multivariable logistic regression.

Results: PSCI occurred in 52.1% at 3 months after stroke. Patients with very bad sleep quality before stroke were at increased risk of PSCI (OR, 2.11; 95% CI, 1.11-4.03; P=0.03). Subgroup analysis found that the association between very bad sleep quality and PSCI was more evident among patients with high school education or above (OR, 5.73; 95% CI, 1.92-17.10; P for interaction=0.02). In addition, patients with greater sleep fragmentation before stroke were also at higher risk of PSCI (OR, 1.55; 95% CI, 1.20-2.01; P<0.01). Similarly, subgroup analysis showed that the risk of PSCI was more pronounced among patients without employment (OR, 2.45; 95% CI, 1.59-3.77; P for interaction=0.01).

Conclusion: Very bad sleep quality and greater sleep fragmentation before stroke were identified as independent risk factors for PSCI at 3 months after stroke.

Keywords: cognitive impairment; ischemic stroke; subjective sleep status.

Grants and funding

This work was supported by grants from the National Key Research and Development Program of China (2020YFC2005304, 2016YFC1307200).