Determinantes da qualidade do sono em indivíduos pós acidente vascular encefálico crônico

Abstract

Background: Stroke is considered one of the major causes of death and disability in the adult population worldwide. In addition to post-stroke motor and cognitive impairments, up to 70% of individuals in the acute phase and 40% in the chronic phase experience sleep disorders such as insomnia, excessive daytime sleepiness, and sleep-disordered breathing. Previous studies have observed changes in architecture and, consequently, in the sleep quality in post-stroke individuals, showing that sleep disorders can impair the state of daytime waking, cognitive functions and mood, which can negatively influence functional outcomes and quality of life of these individuals. In view of the role of sleep in functional recovery, it is important to investigate the contribution of clinical and functional factors to the sleep quality in this population. Objective: To investigate if variables such as age, functional status, walking capacity, fatigue, depressive symptoms, and quality of life are determinants of sleep quality in individuals after chronic stroke. Methods: This is a cross-sectional exploratory study, approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais, CAAE 02465118.9.0000.5149. Sample comprised of individuals after stroke, who met the inclusion criteria: age ≥20 years, diagnosis of stroke for at least six months, absence of cognitive changes and ability to walk independently. The independent variables were age, functional status, measured by the Modified Rankin Scale, walking capacity in the 6-minute walk test, fatigue, measured by the Fatigue Severity Scale, depressive symptoms, measured by the Geriatric Depression Scale, and quality of life, measured by the EuroQol visual analogue scale. Sleep quality, defined as a dependent variable, was measured by the Pittsburgh Sleep Quality Index. Linear regression analysis was performed to identify which variables could explain the sleep quality in this population. Results: 90 participants were included in the study. Of these, 55 (61%) were men, mean age was 61.1 (SD 12.3) years, and the mean time since the onset of the stroke was 58.2 (SD 58.7) months. Regression analysis showed that sleep quality was associated with depressive symptoms and functional status. Depressive symptoms explained 22% (F=25.76; p<0.00) of the variance in the Pittsburgh Sleep Quality Index. When functional status was included in the model, the variables together explained 30% (F=20.38; p<0.00). Conclusion: Depressive symptoms and functional status were determinants of sleep quality after chronic stroke. It is important to consider the assessment of sleep quality in the context of stroke rehabilitation and, when possible, improve the modifiable factors associated with sleep quality.