The role of sleep in neurorehabilitation processes in subacute stroke patients: A longitudinal observational study

Introduction: Sleep plays a crucial role in cognitive functioning, emotionalregulation, and physical recovery, all of which are essential componentsof the rehabilitation process for stroke survivors.Understanding the complex interplay between stroke rehabilitationand sleep is essential for optimizing treatment strategies and enhancingpatient outcomes. The present study investigated sleep characteristicsand rehabilitation outcomes to explore their relationship inpatients recovering from subacute stroke.Method: Eighteen patients (11 males; 66.9 ± 11.6 years) in a poststrokerehabilitation program were enrolled. This longitudinal observationalstudy (2 weeks) employed self-reported sleep questionnaires(Pittsburgh Sleep Quality Index, PSQI; Insomnia Severity Index, ISI;Epworth Sleepiness Scale, ESS) administered at the initial phase (T0).Prospective sleep and rehabilitation measures were longitudinally collectedusing Pittsburgh Rehabilitation Participation Scale (PRPS), wristactigraphy (ActiWatch) and sleep diaries. Functional independence(Barthel Index), motor performance (Nine-Hole Peg Test, NHPT;10 Meter Walk Test, 10MWT) and motor imagery (Imagery PerformanceIndex, IPI) were evaluated at T0 and at the end of the twoweekprotocol (T1). Comparison analyses (t-test or Wilcoxon) andanalysis of variance (one-way ANOVA) were conducted to observeany variation over the observation period. Further, correlation analyses(Pearson or Spearman correlations) were performed to investigatethe relationship between rehabilitation outcomes and sleeprelatedaspects.Results: Significant improvements were observed in Barthel Index(p < 0.001), and motor performance (NHPT, 10MWT) (p = 0.02) fromT0 to T1. The correlation analyses showed, consistent with thehypotheses, a relationship between better motor performance andhigher level of independence (r =  0.66; p = 0.03) and participation(r =  0.63; p = 0.04). Finally, we observed worse motor performancein patients with more severe insomnia symptoms (r =  0.47;p = 0.04), and a greater degree of independence negatively correlatedwith the time spent sleeping (r =  0.73; p < 0.001).Conclusion: In this study it was highlighted that independence andparticipation correlate with motor performance, and that some sleepmeasures correlate with the level of patient autonomy and rehabilitationoutcomes. This underscores the need to consider sleep characteristicsin these patients to establish more effective rehabilitationprotocols.