Megan Brooks

June 08, 2017

BOSTON — Stroke survivors who sleep for more than 8 hours a night on average are at increased risk of having problems completing instrumental activities of daily living (IADLs), new research suggests.

IADLs are activities that involve more of a cognitive component, such as taking medications as prescribed, grocery shopping, using the telephone, preparing meals, and managing money.

"Healthcare providers should ask about sleep habits in stroke survivors. If we don't, we are doing a disservice to our patients," Azizi Seixas, PhD, from NYU School of Medicine in New York City, told Medscape Medical News.

The findings were presented here at SLEEP 2017: 31st Annual Meeting of the Associated Professional Sleep Societies.

Dr Seixas and colleagues assessed the association between sleep duration and daily functioning in stroke survivors. They looked at roughly 15 years of data on more than 1.1 million adults (mean age, 46 years) participating in the National Health Interview Survey, including information on sociodemographic variables, self-reported stroke history, problems with IADLs, and sleep duration.

Roughly half were women, about two thirds were currently working, and 90% reported their general health status as excellent to good.

About 30% of stroke survivors reported problems with IADLs and 34% of respondents who reported problems with IADLs were short sleepers. Average sleep (reference) was defined as 7 to 8 hours per day, short sleep as fewer than 6 hours per night, and long sleep as more than 8 hours nightly.

Among stroke survivors, after adjustment for the effects of age, sex, race, marital status, health status, and income, long sleepers were 97% more likely than average sleepers to report problems with IADLs (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.71 - 2.26; P < .001).

Among people with no history of stroke, both short sleep (OR, 1.24; 95% CI, 1.18 - 1.30) and long sleep (OR, 2.65; 95% CI, 2.49 - 2.82) were predictive of problems with IADLs.

Sleep duration seems to matter when it comes to IADLs, Dr Seixas noted in an interview.  "The presence of short and long sleep makes it worse, and particularly long sleep among stroke survivors."

"Stroke damages the brain," he added, "so to recuperate you might actually get longer sleep but what we are actually seeing is that if you do get longer sleep that might not be beneficial in your recovery as it relates to quality of life, particularly in doing some of the important daily activities to get back to a state of normalcy."

"We're not saying that sleep is actually driving the cognitive problems because we can't establish causality," Dr Seixas said.

Commenting on the findings for Medscape Medical News, Steven Feinsilver, MD, director of sleep medicine at Lenox Hill Hospital in New York City, said, "Bad sleep correlates with all sorts of things, but it's not clear what is causation."

The "huge data set" is an advantage of the study, he noted, "but this is people self-reporting their sleep subjectively. The advantage with a sleep lab is we know exactly how much you slept, but only that one or two nights in the sleep lab. We need a study that monitors people day to day to assess their sleep, and we are getting close to that with fitness trackers and other mobile devices, which are pretty good. They aren't great at the moment, but I bet they will be," Dr Feinsilver said.

"It would be great to put a fitness tracker on all these people and see how much they are really sleeping and see what you can correlate that with," he added.

The study had no commercial funding. Dr Seixas and Dr Feinsilver have disclosed no relevant financial relationships.

SLEEP 2017: 31st Annual Meeting of the Associated Professional Sleep Societies. Poster 1055. Presented June 5, 2017.

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