Impact of Persistent Poor Sleep Quality on Post-Stroke Anxiety and Depression: A National Prospective Clinical Registry Study

Xiao-Wei Fan,1– 4,&ast; Yang Yang,2– 5,&ast; Shuo Wang,2– 5 Yi-Jun Zhang,1– 4 An-Xin Wang,1– 4 Xiao-Ling Liao,1– 4 Wei-Guo Ma,6 Ning Zhang,2– 5 Chun-Xue Wang,2– 5,7 Yong-Jun Wang1– 4 1Department of Neurology, Capital Medical University, Beijing, People’s Republic of China; 2Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Capital Medical University, Beijing, People’s Republic of China; 6Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 7Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ning Zhang; Chun-Xue Wang, Beijing Tiantan Hospital, 119 South 4th Ring West Road, Beijing, 100070, People’s Republic of China, Tel +86-15801203052 ; +86-13701193710, Email 827582777@qq.com; snowsen@126.comPurpose: The impact of poor sleep quality after stroke, especially persistent poor sleep quality, on poststroke anxiety and depression is unclear. We seek to investigate the impact of baseline and persistent poor sleep quality on short-term poststroke anxiety and depression.Patients and Methods: Data were analyzed for 1619 patients with acute ischemic stroke from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients study (ICONS). The sleep quality was assessed at 2 weeks and 3 months using the Pittsburgh Sleep Quality Index scale (PSQI). Poor sleep quality was defined as a PSQI score of > 5, and persistent poor sleep quality was defined as a PSQI score of > 5 at each time point. Patients were divided into three groups according to the quality of sleep: good sleep quality, baseline poor sleep quality and persistent poor sleep quality. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 scale (GAD-7), and Modified Rankin Scale (mRS) at 3 months after stroke were taken as the study outcomes.Results: Persistent poor sleep quality was present in 70.2% of patients after stroke. Compared to those with good sleep quality, patients with baseline poor sleep quality did not show significant differences in disability, anxiety and depression. However, patients with persistent poor sleep were at increased risk of depression (odds ratio, OR 3.04, 95% confidence interval, CI 1.66– 5.57, P < 0.01) and anxiety (OR 3.20, 95% CI 1.42– 7.19, P < 0.01) at 3 months after stroke. Persistent poor sleep quality was not identified as a risk factor for functional disability at 3 months.Conclusion: Patients with persistent poor sleep quality are at added risks for depression and anxiety after stroke.Keywords: sleep quality, depression, anxiety, ischemic stroke