Analysis of Various Sleep Architecture Parameters Using Polysomnography among Patients with Recurrent Stroke: A Cross-Sectional Study at A Tertiary Care Hospital in Rajasthan

Background: Sleep-disturbance is an increasingly recognized disorder that is particularly prevalent among stroke patients. Despite the known association between sleep disturbances and stroke, the prevalence and pattern of sleep disturbances among patients with recurrent strokes is not well defined.

Objectives: The present study was conducted to evaluate sleep architecture in patients with recurrent stroke and to study correlations of various sleep parameters with number of stroke among the patients of recurrent strokes.

Subjects & Method: This hospital based observational cross-sectional study was conducted under the Department of Neurology in a tertiary care hospital setting, on the patients with recurrent stroke (ischemic as well as hemorrhagic stroke). Sixty five patients with diagnosis of more than one stroke within 7 days of last stroke were included in the study after obtaining informed written consent and satisfying inclusion and exclusion criteria. The patients were divided into three groups on the basis of number of strokes, i.e., 2, 3 and 4 strokes. Detailed history and clinical examinations were performed. Patient underwent one night polysomnography to obtain sleep parameters; following which they were enquired about sleep quality and daytime sleepiness. Correlations between sleep parameters and number of strokes were established using IBM SPSS software version 23.0.  P value of less than 0.05 was considered significant.

Results: Mean Total Sleep Time (TST), Mean Sleep Period Time (SPT) and Sleep Efficiency were found to have an inverse and statistically significant correlation with number of strokes (P<0.0001); while Sleep Latency showed direct correlation with number of strokes (P<0.0001). Only 43.08% (28/65) patients could attain REM stage. All those were from 2 stroke group and none from 3 or 4 stroke groups. Apnea Hypopnea Index and Arousal Index were found to be increasing with higher number of strokes; while Mean average saturation and Mean minimum saturation were found to be decreasing with higher number of strokes among the study population (P<0.0001). It was observed that with higher number of strokes, Epworth Sleepiness Scale (ESS) score also increases (P<0.0001).

Conclusion: Number of strokes shows statistically significant correlation with sleep architecture. Increasing number of strokes adversely affect sleep parameters