Article

OBJECTIVE: To investigate whether objective polysomnographic measures of
prevalent sleep problems such as sleep-disordered-breathing (SDB) and insomnia
are associated with activities of daily living levels in inpatients at
rehabilitation units. DESIGN: Retrospective and observational study. SETTING:
Single rehabilitation center. PARTICIPANTS: Inpatients with subacute stroke
(N=123) (61.6+/-13.1 years; 23.8+/-3.4 kg/m(2); 33% women; 90.5+/-36.7 days
post-stroke) underwent a 1-night polysomnographic study and a 1-month inpatient
rehabilitation program. MAIN OUTCOME MEASURES: Admission and discharge Barthel
Index (BI) scores and its change scores. RESULTS: One hundred three (92%)
patients had moderate-to-severe SDB (46.7+/-25.1 events/h in the apnea-hypopnea
index), and 24 (19.5%) patients had acceptable continuous positive airway
pressure adherence. Diverse values were found for total sleep time (259+/-71
min), sleep efficiency (69.5%+/-19.3%), sleep latency (24.3+/-30.9 min), and
wakefulness after sleep onset (93.1+/-74.2 min). Admission BI scores and the BI
change scores were 33.8+/-23.2 and 10.1+/-9.2, respectively. The National
Institutes of Health Stroke Scale (NIHSS, 10.2+/-5.6), available in 57 (46%)
patients, was negatively associated with admission levels and gains in BI change
scores (P<.001, =0.002, respectively) in a univariate analysis. In regression
models with backward selection, excluding NIHSS score, both age (P=.025) and
wakefulness after sleep onset (P<.001) were negatively associated (adjusted
R(2)=0.260) with admission BI scores. Comorbidity of hypertension; sleep latency
percentage of stage 1, non-rapid eye movement sleep; and desaturation events
>/=4% (P<.001, 0.001, 0.021, and 0.043, respectively; adjusted R(2)=0.252) were
negatively associated with BI score gains. CONCLUSIONS: Based on objective sleep
measures, insomnia rather than SDB in inpatients with subacute stroke was
associated negatively with admission levels of activity of daily living and its
improvement after a 1-month rehabilitation course.
CI - Copyright (c) 2018 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS