Abstract
Introduction
Up to one in eight patients may experience post-traumatic stress disorder (PTSD) within the year following a stroke or transient ischemic attack (TIA). Sleep disturbance is a chief complaint in PTSD and is common following stroke. We therefore examined whether sleep was associated with post-stroke PTSD.
Methods
The Reactions to Acute Care and Hospitalization (REACH)-Stroke study is an observational cohort study examining factors related to long-term health outcomes following stroke/TIA. Typical sleep duration (self-report) and quality (1: very good to 4: very bad) over the month following hospital discharge was assessed at 1-month follow-up. At 1 month, patients also completed the PTSD checklist for DSM-5 (PCL-5 cued to the stroke/TIA event). Binary logistic regression was conducted, producing odds ratios (OR) on the association between sleep within the month following discharge and PTSD symptoms at 1 month post-stroke, controlling for age, sex, and race/ethnicity.
Results
Analyses included 459 patients (age: 61.1 ± 15.6 y, 53.2% female). Short sleep (<7 h/night) and poor sleep quality (fairly/very bad) was reported in 49.2% and 25.5% of patients, respectively. Elevated PTSD symptoms (PCL-5 score ≥30) at 1 month were reported in 10.9% of patients. Sleep was significantly shorter and worse quality in those with PTSD vs. without (p-values<0.001). Short sleep duration vs. not short duration throughout the month following discharge was significantly associated with elevated PTSD symptoms at 1-month (OR=3.34, 95% CI: 1.51-7.38, p=0.003). Poor sleep quality (fairly or very bad rating) vs. good sleep (fairly or very good rating) was also significantly associated with elevated PTSD symptoms at 1-month (OR=2.23, 95% CI: 1.13-4.41, p=0.021).
Conclusion
Patients with short duration and poor quality sleep in the month following stroke are at an increased risk of having elevated PTSD symptoms. Understanding factors related to the development of post-stroke PTSD is important since PTSD in stroke survivors can reduce quality of life, contribute to non-adherence to prescribed medications, and increase risk of recurrent stroke and/or cardiovascular events. Future studies should be conducted to determine whether sleep is a modifiable determinant of PTSD symptoms after stroke.
Support
R01HL141494, R01HL132347
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