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Ύπνος κατά τη διάρκεια νοσηλείας ασθενών με αγγειακό εγκεφαλικό επεισόδιο (Master thesis)

Τσιμπονάκης, Αθανάσιος

Sleep disorders take place in a great proportion of hospitalized patients during the acute phase of their disease, with negative impact in their outcome and rehabilitation. Stroke patients often exhibit sleep disorders, with the most common one being obstructive sleep apnea. The aim of the present study was to investigate the sleep conditions during hospitalization of those patients and to investigate the possible correlation between the sleep parameters and the patients’ characteristics as much as the possible correlation between the sleep parameters and the parameters of stroke (severity, location, outcome). Thirty (30) acute stroke inpatients in the 2nd Department of Neurology of the University General Hospital “Attikon” were recruited for the present study, while the control group consisted of twelve (12) hospitalized patients with similar demographics. All patients were asked to complete a sleep questionnaire, for the assessment of sleep quality, to keep a sleep diary during hospitalization, for the assessment of sleep quantity and mid-sleep awakenings, and to complete the STOP-BANG questionnaire for the assessment of possible OSA (obstructive sleep apnea). The location of the lesion at stroke patients was identified with the aid of brain CT or MRI, while the stroke severity and outcome were assessed with the NIHSS and mRS scales, respectively. We found that the majority of patients slept adequately in terms of sleep quantity with a normal number of mid-sleep awakenings and an average score in terms of sleep quality, with the most common causes of sleep disturbance being night-time nursing interventions and noise from other patients. Moreover, the male sex was associated with better sleep quality and quantity, whereas age was associated with better sleep quality. Regarding the possibility of OSA, it was shown that 67% of stroke patients were at high risk of OSA, in comparison with 33% of the control group. Furthermore, a statistically significant association was found between the greater number of mid-sleep awakenings and the higher probability of OSA among the patients. Stroke severity had a positive correlation with the parameter of mid-sleep awakenings, as it was shown that patients with a higher score in the NIHSS scale had a greater number of mid-sleep awakenings and sleep fragmentation. In addition, a statistically significant association was found between the number of mid-sleep awakenings and the patients’ outcome, as it was shown that patients with a greater number of mid-sleep awakenings had a poorer outcome. To summarize, the present study demonstrated the current sleep conditions during hospitalization of stroke patients. Sleep disorders were associated with greater stroke severity and poorer stroke outcome. Due to these findings, the inclusion of sleep assessment in hospitalized stroke patients and its promotion with appropriate sleep hygiene is strongly advised. Future studies with a larger sample size are needed, to better understand the relation between sleep and stroke and to adopt appropriate medical practices.