Ren-Jing Huang1, Ching-Hsiang Lai2, Shin-Da Lee3, Fang-Yu Pai4, Shen-Wen Chang5, Ai-Hui Chung5, Yi-Fang Chang6, Hua Ting7. 1. Department of Medical Image and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan; Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan. 2. Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan. 3. Department of Occupational Therapy, Asia University, Taichung, Taiwan; Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan; School of Rehabilitation Science, Shanghai University of TCM, Shanghai, China. 4. Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan. 5. Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan. 6. Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan. 7. Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address: huating@csmu.edu.tw.
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.
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.
Authors: Pin-Wei Chen; Megan K O'Brien; Adam P Horin; Lori L McGee Koch; Jong Yoon Lee; Shuai Xu; Phyllis C Zee; Vineet M Arora; Arun Jayaraman Journal: Sensors (Basel) Date: 2022-08-18 Impact factor: 3.847