Circadian and homeostatic changes of sleep-wake and quality of life in stroke: implications for neurorehabilitation.

The present study aimed to assess changes in the circadian and homeostatic control of the sleep-wake pattern in stroke patients and correlations with quality of life. Participants were 22 patients (55 ± 12 years) and 24 healthy subjects (57 ± 11 years). Instruments used were: the Pittsburgh Sleep Quality Index, SF-36 Questionnaire and Actigraphy. Data were analyzed by Mann-Whitney test and Spearman's correlation. Results identified a significant difference in sleep quality and quality of life between patients and healthy subjects, with patients on average exhibiting poor sleep quality (patients: 8.4 ± 3.4; healthy subjects: 6.2 ± 2.5; p = 0.0001) and low quality of life scores (p < 0.001). Correlation analysis detected an association between circadian variables (total activity, start and finish times of activity) and quality of life (p < 0.001). Associations between homeostatic variables (sleep duration, latency and efficiency) and quality of life were also significant (p < 0.001). In conclusion, results in this study showed compromised sleep quality and quality of life in the patients evaluated, associated with circadian and homeostatic alterations. This suggests that complaints regarding poor sleep quality be taken into consideration when planning the rehabilitation of stroke patients.