Abstract
Objective
To investigate whether objective polysomnographic measures of prevalent sleep problems
such as sleep-disordered-breathing (SDB) and insomnia are associated with activities
of daily living levels in inpatients at rehabilitation units.
Design
Retrospective and observational study.
Setting
Single rehabilitation center.
Participants
Inpatients with subacute stroke (N=123) (61.6±13.1 years; 23.8±3.4 kg/m2; 33% women; 90.5±36.7 days post-stroke) underwent a 1-night polysomnographic study
and a 1-month inpatient rehabilitation program.
Main outcome measures
Admission and discharge Barthel Index (BI) scores and its change scores.
Results
One hundred three (92%) patients had moderate-to-severe SDB (46.7±25.1 events/h in
the apnea-hypopnea index), and 24 (19.5%) patients had acceptable continuous positive
airway pressure adherence. Diverse values were found for total sleep time (259±71
min), sleep efficiency (69.5%±19.3%), sleep latency (24.3±30.9 min), and wakefulness
after sleep onset (93.1±74.2 min). Admission BI scores and the BI change scores were
33.8±23.2 and 10.1±9.2, respectively. The National Institutes of Health Stroke Scale
(NIHSS, 10.2±5.6), available in 57 (46%) patients, was negatively associated with
admission levels and gains in BI change scores (P<.001, =0.002, respectively) in a
univariate analysis. In regression models with backward selection, excluding NIHSS
score, both age (P=.025) and wakefulness after sleep onset (P<.001) were negatively associated (adjusted R2=0.260) with admission BI scores. Comorbidity of hypertension; sleep latency percentage
of stage 1, non–rapid eye movement sleep; and desaturation events ≥4% (P<.001, 0.001, 0.021, and 0.043, respectively; adjusted R2=0.252) were negatively associated with BI score gains.
Conclusions
Based on objective sleep measures, insomnia rather than SDB in inpatients with subacute
stroke was associated negatively with admission levels of activity of daily living
and its improvement after a 1-month rehabilitation course.
Keywords
List of abbreviations:
ADL (activities of daily living), AHI (apnea-hypopnea index), AI (arousal index), BI (Barthel Index), CPAP (continuous positive airway pressure), LACI (lacunar circulation infarct), NIHSS (National Institutes of Health Stroke Scale), PACI (partial anterior circulation infarcts), POCI (posterior circulation infarcts), PSG (polysomnography), Sao2 (oxygen saturation), SDB (sleep-disordered breathing), TACI (total anterior circulation infarcts)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 12, 2018
Footnotes
Supported by the Taiwan Ministry of Health and Welfare Clinical Trial Center (grant no. MOHW106-TDU-B-212-113004), by China Medical University Hospital (grant no. BDRC grant), and by the Program for Professor of Special Appointment (Eastern Scholar, Honorary Chair Professor) at Shanghai Institute of Higher Education (no. 2012-47).
Our subjects were sampled retrospectively from patients hospitalized in the stroke rehabilitation unit of the Department of Rehabilitation, Chung Shan Medical University Hospital, Taiwan, from January 1, 2012, to December 31, 2013.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
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- CorrectionArchives of Physical Medicine and RehabilitationVol. 99Issue 8
- PreviewIn the article by Huang et al, Objective sleep measures in inpatients with subacute stroke associated with levels and improvements in activities of daily living, published in Archives of Physical Medicine and Rehabilitation 2018; 99: 699-706 ( https://doi.org/10.1016/j.apmr.2017.12.016 ), we failed to note that the authors Ren-Jing Huang PhD, Ching-Hsiang Lai PhD, and Shin-Da Lee PhD all contributed equally to this study. We apologize for this error.
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