Development of insomnia in patients with stroke: A systematic review and meta-analysis

PLoS One. 2024 Apr 10;19(4):e0297941. doi: 10.1371/journal.pone.0297941. eCollection 2024.

Abstract

Background and aim: Stroke is a serious threat to human life and health, and post-stroke insomnia is one of the common complications severely impairing patients' quality of life and delaying recovery. Early understanding of the relationship between stroke and post-stroke insomnia can provide clinical evidence for preventing and treating post-stroke insomnia. This study was to investigate the prevalence of insomnia in patients with stroke.

Methods: The Web of Science, PubMed, Embase, and Cochrane Library databases were used to obtain the eligible studies until June 2023. The quality assessment was performed to extract valid data for meta-analysis. The prevalence rates were used a random-efect. I2 statistics were used to assess the heterogeneity of the studies.

Results: Twenty-six studies met the inclusion criteria for meta-analysis, with 1,193,659 participants, of which 497,124 were patients with stroke.The meta-analysis indicated that 150,181 patients with stroke developed insomnia during follow-up [46.98%, 95% confidence interval (CI): 36.91-57.18] and 1806 patients with ischemic stroke (IS) or transient ischemic attack (TIA) developed insomnia (47.21%, 95% CI: 34.26-60.36). Notably, 41.51% of patients with the prevalence of nonclassified stroke developed insomnia (95% CI: 28.86-54.75). The incidence of insomnia was significantly higher in patients with acute strokes than in patients with nonacute strokes (59.16% vs 44.07%, P < 0.0001).Similarly, the incidence of insomnia was significantly higher in the patients with stroke at a mean age of ≥65 than patients with stroke at a mean age of <65 years (47.18% vs 40.50%, P < 0.05). Fifteen studies reported the follow-up time. The incidence of insomnia was significantly higher in the follow-up for ≥3 years than follow-up for <3 years (58.06% vs 43.83%, P < 0.05). Twenty-one studies used the Insomnia Assessment Diagnostic Tool, and the rate of insomnia in patients with stroke was 49.31% (95% CI: 38.59-60.06). Five studies used self-reporting, that the rate of insomnia in patients with stroke was 37.58% (95% CI: 13.44-65.63).

Conclusions: Stroke may be a predisposing factor for insomnia. Insomnia is more likely to occur in acute-phase stroke, and the prevalence of insomnia increases with patient age and follow-up time. Further, the rate of insomnia is higher in patients with stroke who use the Insomnia Assessment Diagnostic Tool.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Humans
  • Ischemic Attack, Transient* / etiology
  • Ischemic Stroke* / complications
  • Quality of Life
  • Sleep Initiation and Maintenance Disorders* / complications
  • Sleep Initiation and Maintenance Disorders* / epidemiology
  • Stroke* / epidemiology

Grants and funding

This work was supported by Administration of Traditional Chinese medicine in guangxi, self-financing scientific research subject[grant numbers GXZYA20220072]; Natural Science Foundation of Guangxi[grant numbers 2023GXNSFAA026200]; Hospital scientific research project of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine[grant numbers 2021QN008]; Guangxi University of Traditional Chinese Medicine research project[grant numbers 2022QN019]. This work was supported by Junwei YANG and Qingjing TAN.