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Sleep in stroke survivors who have difficulty with their movement

 

Why did we do this research?

Sleep is important for learning new skills. A good night’s sleep after learning a skill can boost your performance when you next attempt it. This is because, while sleeping, the brain organises the memories associated with that skill so that you become more efficient at it once you wake up.

After stroke, people often have difficulty with their movement. Relearning this movement can take a long time and a lot of effort.  Good sleep quality is likely to be important in giving the best chance of regaining this movement.

Sleep problems are often reported by people after stroke. However, we don’t yet know much about how sleep problems change over time and how sleep relates to other aspects of recovery.

 

What did we aim to find out?

In our study, we aimed to look at whether there is a relationship between sleep quality and ability to move the hand and arm in people who had their stroke more than 3 months previously.

We also asked whether sleep difficulties were related to how long ago someone had a stroke, or to other aspects of recovery such as activity and mood.

 

Who did we include in the study?

69 stroke survivors took part in the study as well as a control group of 63 people who had not had a stroke.

 

How did we measure sleep quality?

The Sleep Condition Indicator (SCI) questionnaire was used to ask people about their average sleep quality over the past month.

An activity monitor was worn on the wrist for one week. The monitor records sleep disruption by looking at movement.

 

How did we measure ability to move the arm?

For the stroke survivors, we assessed how well they could move their arms and legs with a test known as the Fugl-Meyer Assessment. This measured how well people could make different movements of their hand and arm, such as moving the arm in front or to their side, moving the hand in different patterns and grasping different objects.

 

What did we find out?

Responses to the SCI sleep questionnaire showed that stroke survivors rated their sleep quality as lower than the control group.  

Furthermore, the activity monitors showed that, on average, stroke survivors spent more time awake overnight. 

We found that there was no relationship between sleep quality and movement ability or between sleep quality and time since stroke.

 

When looking at both groups, of those who had experienced stroke and those who had not had a stroke, we found that:

1)    People with more symptoms of depression had lower ratings of sleep quality

2)    Disrupted sleep was more common with older age

 

What does this mean?

As we expected, people who had experienced a stroke showed poorer sleep quality compared to the group who hadn’t had a stroke. Importantly, for people with less movement of the hand/arm we did not find more sleep disruption.

However, poor sleep quality seems to persist long-term after stroke and people with poor sleep are more likely to also have low mood. 

In the future we will investigate different ways of improving people’s sleep quality and see whether this can also help improve symptoms of depression.

We are starting to do this by first looking at whether an online sleep improvement programme is effective in people who have had a stroke.

 

Email: Dr Melanie Fleming, sleep-win@ndcn.ox.ac.uk

Phone: 01865 611 461

 

 

Thank you to everyone who took part or helped us with this study.

Thank you to the Wellcome Trust for funding this research.

 

 

Our team