SLEEP DISTURBANCES AND THEIR CLINICAL CORRELATES IN PATIENTS WITH ACUTE ISCHEMIC STROKE: A HOSPITAL BASED CROSS-SECTIONAL STUDY

Abstract

Background: Sleep disturbances occur frequently after acute ischemic stroke (AIS) and are increasingly recognised as a modifiable determinant of neurological recovery, yet their clinical correlates in the acute Indian in-patient setting remain under-studied. Objective: To determine the prevalence of sleep disturbance in patients with AIS and to examine its association with demographic, clinical, radiological and mood-related variables. Materials and Methods: In this hospital-based observational cross-sectional study, 50 consecutive adults admitted with neuroimaging-confirmed AIS to the Department of Neurology of a tertiary care teaching hospital were evaluated between Day 1 and Day 7 of admission. Sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS); depressive symptoms were screened with the Patient Health Questionnaire-9 (PHQ-9). Stroke severity (NIHSS), TOAST subtype, lesion location, thrombolysis status and comorbidities were recorded. Continuous variables were compared using the independent-samples t-test or Mann-Whitney U test, categorical variables by the chi-squared or Fisher exact test, and associations by Pearson/Spearman correlation; p<0.05 was considered significant. Results: Mean age was 56.62 ± 15.71 years (68% male). Mean PSQI score was 4.70 ± 2.48 and mean ESS score was 4.02 ± 3.44; 23 of 50 patients (46.0%) had poor sleep quality (PSQI >5). Sleep quality was not significantly related to stroke severity (r = -0.118, p = 0.418), lesion vascular territory (χ2 = 2.84, p = 0.724) or thrombolysis status, but showed a significant positive correlation with depressive symptoms (PHQ-9 vs PSQI: r = 0.421, p = 0.002; PHQ-9 vs ESS: r = 0.338, p = 0.016). Poor sleep quality and higher daytime sleepiness were both more prevalent among patients with cerebellar lesions (66.7%) and among those older than 60 years, although these sub-group differences did not reach statistical significance. Conclusion: Poor sleep quality affects nearly half of patients in the acute phase of ischemic stroke. Unlike stroke severity or lesion location, depressive symptoms were significantly and consistently associated with poorer sleep, suggesting that mood screening should accompany sleep assessment in acute stroke care.