From the Guidelines
The Pittsburgh Sleep Quality Index (PSQI) should be routinely used to assess sleep quality in stroke patients, as poor sleep quality can negatively impact rehabilitation outcomes, cognitive function, and increase the risk of recurrent stroke. When evaluating stroke patients, I recommend incorporating the PSQI as part of post-stroke assessment protocols, ideally within the first few weeks after stroke and at regular follow-up intervals 1. The PSQI consists of 19 self-rated questions that evaluate seven sleep components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Scores range from 0-21, with higher scores indicating worse sleep quality and a score above 5 suggesting poor sleep quality.
Some key points to consider when using the PSQI in stroke patients include:
- The PSQI can help identify sleep disturbances that are common after stroke, including insomnia, sleep-disordered breathing, and circadian rhythm disruptions 1
- Interventions should be tailored to the specific sleep disturbance and may include cognitive behavioral therapy for insomnia, as recommended by the American College of Physicians 1
- Proper sleep hygiene education and in some cases, short-term medication like trazodone 25-100mg or low-dose melatonin 1-3mg may also be beneficial
- Addressing sleep problems is particularly important in stroke recovery, as improving sleep quality may enhance neuroplasticity and recovery processes 1
Overall, the use of the PSQI in stroke patients can help identify and address sleep disturbances, ultimately improving rehabilitation outcomes, cognitive function, and reducing the risk of recurrent stroke. By prioritizing sleep quality assessment and intervention, healthcare providers can take a crucial step towards improving the overall health and well-being of stroke patients.
From the Research
PSQI and Stroke
- The Pittsburgh Sleep Quality Index (PSQI) is a validated scale used to measure sleep quality, and its relationship with stroke has been investigated in several studies 2, 3.
- A systematic review and meta-analysis found that the pooled prevalence of poor sleep quality after stroke was 53% (95% CI 41-65%), with studies using PSQI having a prevalence of 49% (95% CI 26-71%) with a cutoff point of 7, and 66% (95% CI 63-69%) with a cutoff point of 5 2.
- Another study found that participants with poor baseline sleep quality had a significantly higher long-term risk of stroke compared with those with good sleep quality (hazard ratio [HR] 2.37,95% confidence intervals [CI] 1.44,3.91) 3.
Sleep Quality and Stroke Risk
- Sleep disorders, including poor sleep quality, have been identified as risk factors for stroke 4, 5.
- A narrative review found that sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome, and can also occur secondary to the stroke itself 5.
- The relationship between sleep duration and stroke risk has been explored, with findings suggesting a U-shaped relationship between sleep duration and cardiovascular outcomes, including stroke 6.
Assessment and Management
- Recent guidelines suggest screening for sleep disorders after stroke, and treatment of sleep disorders could potentially reduce stroke risk and improve stroke outcome 5.
- Healthcare professionals are recommended to proactively assess and manage sleep patterns to mitigate stroke risk, considering individual variations in optimal sleep duration and the potential confounding effects of sleep quality and other sleep-related disorders 6.