The Course and Impact of Poststroke Insomnia in Stroke Survivors Aged 18 to 65 Years: Results from the Psychosocial Outcomes In StrokE (POISE) Study .
BACKGROUND
Insomnia symptoms are common in the population and have negative psychosocial and functional sequelae. There are no prospective studies of the course of such symptoms and their impact, if any, in stroke survivors. This prospective cohort study investigated insomnia after stroke in working-age adults and evaluated its impact on psychological and functional outcomes over the subsequent year.


METHODS
We prospectively recruited 441 young (<65 years) consecutive stroke survivors from 20 public hospitals in the New South Wales Stroke Service network. Participants were assessed by self-report and interview at 28 days, 6 months, and 12 months after stroke. Insomnia was defined using a common epidemiological measure of sleep disturbance and daytime consequences. Depression, anxiety, disability, and return to work were assessed through standardized measures.


RESULTS
The point prevalence of insomnia at each time point in the year after stroke was stable at 30-37% and more common in females. Fifty-eight (16%) of all participants reported "chronic" insomnia, with symptoms at both baseline and 6 months later. At 12 months, this group was more likely to be depressed (OR 6.75, 95% CI 2.78-16.4), anxious (OR 3.31, 95% CI 1.54-7.09), disabled (OR 3.60, 95% CI 2.07-6.25), and not have returned to work, compared to those without insomnia over the same period.


CONCLUSIONS
Chronic insomnia has a negative effect on disability and return to work 1 year after stroke even after adjusting for demographic, psychiatric, and disability factors. Identifying and appropriately targeting insomnia through known effective treatments may improve functional outcomes after stroke. .
Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.
Nick
N
Glozier
The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia.
Tom J
TJ
Moullaali
Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway.|The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.|Department of Psychiatry, Helse Fonna HF, Haugesund, Norway.
Børge
B
Sivertsen
Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.
Dukyeon
D
Kim
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Gillian
G
Mead
The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia.
Stephen
S
Jan
The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia.
Qiang
Q
Li
Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.|The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia.|School of Health, University of Central Lancashire, Preston, United Kingdom.
Maree L
ML
Hackett
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D062707:Return to Work; D012307:Risk Factors; D057566:Self Report; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors; D055815:Young Adult
Anxiety; Cohort ; Depression; Disability; Insomnia; Stroke; Work