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Response to Letter to the Editor: Poststroke Fatigue at Admission is Associated With Independence Levels of Activities of Daily Living at Discharge From Subacute Rehabilitation Wards

      We would like to thank the authors of the letter to the editor related to our article.
      • Oyake K
      • Otaka Y
      • Matsuura D
      • Honaga K
      • Mori N
      • Kondo K.
      Poststroke fatigue at admission is associated with independence levels of activities of daily living at discharge from subacute rehabilitation wards.
      They suggested considering the effects of sleep disorders on functional outcome, given that sleep disorders are frequently observed in patients with stroke
      • Tanayapong P
      • Kuna ST.
      Sleep disordered breathing as a cause and consequence of stroke: a review of pathophysiological and clinical relationships.
      and patients with sleep disorders sometimes complain of fatigue instead of sleepiness.
      • Monderer R
      • Ahmed IM
      • Thorpy M.
      Evaluation of the sleepy patient: differential diagnosis.
      We completely agree with the importance of assessing sleep disorders because patients with stroke can lack symptoms of sleep-disordered breathing (SDB).
      • Arzt M
      • Young T
      • Peppard PE
      • et al.
      Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke.
      Regarding this context, we previously investigated the prevalence of SDB using a portable sleep-monitoring device and the effect of SDB on functional outcome in patients with stroke (n=433) in rehabilitation wards.
      • Matsuura D
      • Otaka Y
      • Kamigaichi R
      • Honaga K
      • Kondo K
      • Prevalence Liu M.
      effect on functional outcome, and treatment of sleep-disordered breathing in patients with subacute stroke.
      The study revealed a high prevalence of SDB: 87.3% of the patients had a respiratory event index (REI) of ≥5 events/h, and 46.4% had an REI of ≥15 events/h.
      • Matsuura D
      • Otaka Y
      • Kamigaichi R
      • Honaga K
      • Kondo K
      • Prevalence Liu M.
      effect on functional outcome, and treatment of sleep-disordered breathing in patients with subacute stroke.
      Excessive daytime sleepiness assessed based on an Epworth Sleepiness Scale score of ≥11 was observed in only 5.2% of patients,
      • Matsuura D
      • Otaka Y
      • Kamigaichi R
      • Honaga K
      • Kondo K
      • Prevalence Liu M.
      effect on functional outcome, and treatment of sleep-disordered breathing in patients with subacute stroke.
      suggesting that most patients with SDB did not have self-reported symptoms, as reported previously.
      • Arzt M
      • Young T
      • Peppard PE
      • et al.
      Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke.
      Although functional outcomes were significantly poorer in patients with SDB than in those without SDB, we found that REI was not a significant independent factor for functional outcome at discharge when adjusted for potential confounders including baseline functional status.
      • Matsuura D
      • Otaka Y
      • Kamigaichi R
      • Honaga K
      • Kondo K
      • Prevalence Liu M.
      effect on functional outcome, and treatment of sleep-disordered breathing in patients with subacute stroke.
      The study highlighted the need to revisit the question of whether SDB is associated with functional outcome in patients with stroke in rehabilitation wards. Therefore, we did not include SDB in our analyses.
      • Oyake K
      • Otaka Y
      • Matsuura D
      • Honaga K
      • Mori N
      • Kondo K.
      Poststroke fatigue at admission is associated with independence levels of activities of daily living at discharge from subacute rehabilitation wards.
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      References

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        • Otaka Y
        • Matsuura D
        • Honaga K
        • Mori N
        • Kondo K.
        Poststroke fatigue at admission is associated with independence levels of activities of daily living at discharge from subacute rehabilitation wards.
        Arch Phys Med Rehabil. 2021; 102: 849-855
        • Tanayapong P
        • Kuna ST.
        Sleep disordered breathing as a cause and consequence of stroke: a review of pathophysiological and clinical relationships.
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        • Ahmed IM
        • Thorpy M.
        Evaluation of the sleepy patient: differential diagnosis.
        Sleep Med Clin. 2020; 15: 155-166
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        • Young T
        • Peppard PE
        • et al.
        Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke.
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        • Otaka Y
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        effect on functional outcome, and treatment of sleep-disordered breathing in patients with subacute stroke.
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