Oral Presentation Australian and New Zealand Stroke Organisation Conference 2025

The relationship between objective and subjective sleep measures and post-stroke fatigue: Insights from an acute ischaemic stroke cohort (the NORFAST study) (122951)

Dawn B Simpson 1 2 , Caryl Gay 3 4 , Søren Berg 3 , Coralie English 1 2 , Hege Ihle-Hansen 5 , Gisle Berg Helland 6 7 8 , Petra Larssen 3 9 , Ingrid Skogestad 10 , Jan Stubberud 3 11 , Britt Øverland 3 , Anners Lerdal 3 12
  1. Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
  2. University of Newcastle, Callaghan, NEW SOUTH WALES, Australia
  3. Lovisenberg Diaconal Hospital, Oslo, Norway
  4. School of Nursing, University of California San Francisco, San Francisco, United States of America
  5. Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
  6. Department of Neurology, Oslo University Hospital, Oslo, Norway
  7. Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  8. Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
  9. Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
  10. Institute of Nursing, Faculty of Health Science, VID Specialized University, Bergen, Norway
  11. Department of Psychology, University of Oslo, Oslo, Norway
  12. Department of Public Health Sciences and Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway

Background: Post-stroke fatigue during acute stroke persists long-term, affecting rehabilitation, daily activities, and quality of life. While sleep is a complex process potentially influencing post-stroke fatigue, their relationship remains unclear. We aimed in the acute stroke phase to a) describe fatigue and sleep using self-reported and objective sleep measures, b) describe sleep apnoea and c) explore associations between sleep measures and post-stroke fatigue.

Methods: A cross-sectional study examining Norwegian adults within 14 days of first ischemic stroke. Fatigue was assessed with the Fatigue Severity Scale. Self-reported sleep factors (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale) and objective WatchPAT measures (apnoea-hypopnea, sleep time, efficiency, REM/deep sleep) served as exposure variables. Multivariable regression models, adjusted for age, sex, modified Rankin Scale, and depression/anxiety symptoms, were used to examine associations between sleep and fatigue.

Results: Participants (n=107, mean age 65 (SD 14) years, n=65(61%) male) had a mean National Institutes of Health Stroke Scale score of 2.5 [SD 3.3], Fatigue Severity Scale score of 3.11 [SD 1.82], and n=71 (66%) had disturbed sleep (PSQI≥5). Mean total sleep time (n=81) was 7.04 [SD 1.46] hours and 54 (71%) had sleep apnoea. In the final model, only poor sleep quality (b=0.45, p=0.010) was associated with post-stroke fatigue; no other sleep factors, including sleep apnoea, were associated.

Conclusions: During acute stroke, over half of participants reported post-stroke fatigue and disturbed sleep, and two-thirds had sleep apnoea. Only sleep quality was associated with fatigue. Addressing sleep quality in the acute stroke phase may benefit post-stroke fatigue.