Serum hypocretin, neurofilament heavy chain, and interleukin-1β as combined predictors of sleep disorders following acute ischemic stroke

Does your competent? doctor even have a  sleep protocol for you/? When I was in the hospital nurses handed out sleeping pills like candy at 10pm. That IS NOT a sleep protocol!

 Serum hypocretin, neurofilament heavy chain, and interleukin-1β as combined predictors of sleep disorders following acute ischemic stroke

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  Chaowei Wang 1*

• Y

  Yunqing Mao 2

• S

  Shuo Wang 1

• L

  Li Liu 1

• G

  Guang Yao 3

• 1. Department of Neurology, The First Affiliated Hospital of Henan Medical University, Henan Provincial Key Laboratory of Neural Repair and Protein Modification, Henan Provincial International Joint Laboratory of Neural Repair for Senile Dementia, Henan Provincial Engineering Research Center of Neural Repair, Henan Provincial Engineering Technology Research Center of Neural Repair, and Henan Provincial Medical Key Laboratory of Neurology, Weihui, Henan, China

• 2. Department of Neuroelectrophysiology, The First Affiliated Hospital of Henan Medical University, Henan Provincial Key Laboratory of Neural Repair and Protein Modification, Henan Provincial International Joint Laboratory of Neural Repair for Senile Dementia, Henan Provincial Engineering Research Center of Neural Repair, Henan Provincial Engineering Technology Research Center of Neural Repair, and Henan Provincial Medical Key Laboratory of Neurology, Weihui, Henan, China

Abstract

Background:

Sleep disorders represent a common and impactful complication following acute ischemic stroke (AIS). This study aimed to identify clinical risk factors and evaluate the predictive(SOLVE the damn problem! PREDICTIONS ARE FUCKING USELESS! Are you that blitheringly stupid? Yep, I guess you are!) value of serum hypocretin (Hcrt), neurofilament heavy chain (NfH), and interleukin-1 beta (IL-1β) for post-stroke sleep disorders.

Methods:

We conducted a retrospective observational study of 256 patients with AIS. Patients were classified into sleep disorder (n = 161) and non-sleep disorder (n = 95) groups based on their Pittsburgh Sleep Quality Index scores 7 days after stroke onset. Fasting serum levels of Hcrt, NfH, and IL-1β were measured upon admission. We utilized multivariate logistic regression and receiver operating characteristic (ROC) curves to evaluate predictive performance. The combined model was internally validated using 1,000 bootstrap resamples to assess optimism-corrected discriminative performance.

Results:

Sleep disorders were present in 62.9% of patients. Nine independent risk factors were identified: age ≥ 65 years (OR = 2.059), snoring history (OR = 1.980), prior stroke (OR = 2.036), lower ADL scores (OR = 1.839), higher HAMD (OR = 1.726) and NIHSS scores (OR = 1.677), decreased serum Hcrt (OR = 1.863), elevated NfH (OR = 2.020), and elevated IL-1β (OR = 1.793; all p < 0.05). Individual biomarker AUCs ranged from 0.742 to 0.781, whereas the combined three-biomarker model achieved a significantly superior AUC of 0.874 (sensitivity 88.82%, specificity 71.58%). Bootstrap internal validation yielded a mean optimism-corrected AUC of 0.861 (95% CI: 0.812–0.903), indicating robust model performance with minimal overfitting.

Conclusion:

Clinical variables alongside altered levels of Hcrt, NfH, and IL-1β serve as independent predictors(I'd fire you all for predictions rather than solutions!) of post-stroke sleep disorders. The combined three-biomarker panel, reflecting neuroendocrine dysregulation, axonal injury, and systemic inflammation, demonstrates substantially superior predictive accuracy over individual biomarkers and offers a clinically practical tool for early identification of high-risk patients.