Deans' stroke musings: Severely Disturbed Sleep in Patients With Acute Ischemic Stroke on Stroke Units: A Pilot Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, November 22, 2019

Severely Disturbed Sleep in Patients With Acute Ischemic Stroke on Stroke Units: A Pilot Study

I don't think I had a dream for years post stroke. In the hospital sleeping pills were handed out like candy. Can you even get to deep sleep via sleeping pills?

Severely Disturbed Sleep in Patients With Acute Ischemic Stroke on Stroke Units: A Pilot Study

Jeannette Hofmeijer^1,2^*,

Ruud van Kaam^1,2,

Sarah E. Vermeer² and

Michel J. A. M. van Putten^1,3

¹Department of Clinical Neurophysiology, University of Twente, Enschede, Netherlands
²Department of Neurology, Rijnstate Hospital, Arnhem, Netherlands
³Department of Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, Netherlands

Introduction: Previous studies revealed a high prevalence of sleep-wake disturbances in subacute and chronic stroke. We analyzed sleep quantity and quality in patients with hyperacute ischemic stroke on stroke units.

Methods: We categorized sleep stages as N1, N2, N3, and REM according to the 2017 criteria of the American Academy of Sleep Medicine in 23 continuous, overnight EEG registrations from 18 patients, starting within 48 h since the onset of cortical ischemic stroke. Associations between presence and duration of sleep stages, and secondary deterioration or functional outcome were analyzed.

Results: Physiological sleep cycles were seen in none of the patients. Otherwise, sleep stages alternated chaotically, both during day- and during nighttime, with a sleep efficiency of 30% and 10.5 ± 4.4 (mean ± SD) awakenings per hour of sleep. We cannot differentiate between stroke related and external factors. Only few interruptions could be related to planned nightly wake up calls, but turbulence on stroke units may have played a role. Six patients (seven nights) did not reach deep sleep (N3), 10 patients (13 nights) did not reach REM sleep. If reached, the mean durations of deep and REM sleep were short, with 37 (standard deviation (SD) 25) and 18 (SD15) minutes, respectively. Patients with secondary deterioration more often lacked deep sleep (N3) than patients without secondary deterioration [4 (57%) vs. 2 (25%)], but without statistical significance (p = 0.12).

Conclusion: We show that sleep is severely disturbed in patients with acute ischemic stroke admitted to stroke units. Larger studies are needed to clarify associations between deprivation of deep sleep and secondary deterioration.

Introduction

Sleep-wake disturbances are highly prevalent among stroke survivors, with insomnia being reported in up to half of all patients during the first months (1). Insomnia may be a direct consequence of the infarct or associated with environmental factors (1).

In patients with brain infarction or hemorrhage, insomnia was associated with more severe stroke, less functional recovery, and depression (1). Sleep disordered breathing gave an elevated risk of death or recurrent vascular events (2) and stroke recovery was worse in patients with restless legs syndrome (3). Sleep deprivation augmented brain injury in experimental stroke models (4), and drugs to promote non-rapid eye movement (REM) and REM-sleep had a favorable effect on neuroplasticity (5). This suggests that poor sleep may be a modifiable factor, where sleep enhancement may improve recovery of patients with ischemic or hemorrhagic stroke.

Previous studies have focused on the subacute and chronic phases. We analyzed sleep quantity and quality in patients with hyperacute ischemic stroke on stroke units, and related sleep to measures of functional recovery.