Abstract
Objective: This study aimed to determine the prevalence of insomnia and its association with lesion location and post-stroke sequelae in patients with ischemic stroke.
Subjects and Methods: A prospective cross-sectional study was conducted on 103 patients with ischemic stroke treated at the Stroke Department, Military Hospital 103, from June 2023 to July 2024. Insomnia was diagnosed according to DSM-V criteria; lesion locations were identified using 1.5 Tesla brain MRI; disability was assessed by the modified Rankin Scale (mRS); and Restless Legs Syndrome (RLS) was diagnosed following IRLSSG (2014) criteria. Data were analyzed using SPSS version 25.0 with descriptive statistics.
Results: Insomnia indicated a significant association with lesions in the frontal, parietal, occipital lobes, and internal capsule (p < 0.05). Patients with insomnia had higher mean mRS scores (2.35 ± 1.19 vs. 1.47 ± 0.88) and significantly higher rates of post-stroke pain and RLS (p < 0.05). The results revealed that internal capsule lesions (OR = 16.03), post-stroke pain (OR = 5.23), and RLS (OR = 29.65) were independent predictors of insomnia.
Conclusion: Insomnia is a common sequela after ischemic stroke, especially among patients with internal capsule lesions, pain, or restless legs syndrome. Early screening and intervention for sleep disorders should be integrated into rehabilitation programs to improve patients’ quality of life.
Keywords
References
insomnia in patients with stroke: A systematic review and meta-analysis. PloS one vol. 19,4 e0297941. 10 Apr. 2024, doi:10.1371 /journal. pone. 0297941.
Wang H, Huang Y, Li M, et al. Regional brain dysfunction in insomnia after ischemic stroke: A resting-state fMRI study. Front Neurol. 2022 Nov 25:13:1025174. doi: 10.3389/fneur.2022.1025174.
Xu H., Li W, Chen J, et al. Associations between insomnia and large vessel occlusion acute ischemic stroke: An observational study. Clinics (Sao Paulo). 2023 Nov 2:78:100297. doi: 10.1016/j.clinsp.2023.100297.
Mohandas P, Alomari Z, Arti F, et al. A Systematic Review and Meta-Analysis on the Identification of Predictors Associated With Insomnia or Sleep Disturbance in Post-stroke Patients. Cureus. 2024 Mar 20;16(3):e56578. doi: 10.7759/cureus.56578.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington, DC: APA; 2013.
Bassetti CL, Aldrich MS. Sleep and stroke. Sleep Medicine Reviews. 1999;3(3):187–200.
Bonita R, Beaglehole R. Modification of Rankin Scale: Recovery of motor function after stroke. Stroke. 1988 Dec;19(12):1497-500. doi: 10.1161/01.str.19.12.1497.
Allen RP, Picchietti DL, García-Borreguero D, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: Updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – History, rationale, description, and significance. Sleep Med. 2014 Aug;15(8):860-73. doi: 10.1016/j.sleep.2014.03.025.
Joa K.-L, Kim W.-H, Choi H.-Y, et al. The Effect of Sleep Disturbances on the Functional Recovery of Rehabilitation Inpatients Following Mild and Moderate Stroke. Am J Phys Med Rehabil. 2017 Oct;96(10):734-740. doi: 10.1097/PHM.0000000000000744
Kim W.-H, Jung H.-Y, Choi H.-Y, et al. The associations between insomnia and health-related quality of life in rehabilitation units at 1 month after stroke. J Psychosom Res. 2017 May:96:10-14. doi: 10.1016/j.jpsychores.2017.02.008.
Zorgor G, Kabeloglu V, Soysal A. Restless legs syndrome after acute ıschemic stroke and ıts relation to lesion location. Sleep Biol Rhythms. 2022;20(4):551-560. Published 2022 Jun 29. doi:10.1007/s41105-022-00401-9.
Venkateshiah S.B. and Ioachimescu O.C. Restless Legs Syndrome. Critical Care Clinics, 2015. 31(3), 459–472.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2025 Journal of Nursing Science