23678: Actigraphy-Assessed Daytime Sleep, Nighttime Sleep and Functional Outcomes in Patients with Neurological Insult CURRENT SECTIO

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Journal of Neurologic Physical Therapy: Academy of Neurologic Physical Therapy Poster Presentations


Purpose/Hypothesis: Daytime naps may lead to nighttime sleep disruptions, such as difficulty falling asleep or staying asleep during the nighttime. These nighttime sleep impairments may hinder functional recovery post-neurological insult. Relationships between daytime sleep, nighttime sleep, and functional outcomes in patients post-stroke or traumatic brain injury (TBI) warrant further study. The purpose of this study was to determine whether daytime sleep duration could predict nighttime sleep duration in patients admitted to an inpatient rehabilitation facility (IRF) for stroke or TBI. A secondary purpose was to assess whether daytime or nighttime sleep duration were predictive of functional outcomes. Number of Subjects: Thirty-five subjects (65.2±17.0 years, 22 male) completed the study. Subjects were admitted to an IRF for subacute rehabilitation after stroke (n=28) or TBI (n=7). Materials and Methods: Sleep was measured with wrist actigraphy, worn continuously on the unaffected arm. The first two full 24-hour periods after entrance into the study were analyzed to determine sleep duration during the daytime (06:00- 20:59) and nighttime (21:00-05:59) periods. Functional Independence Measure (FIM) scores were collected at admission and discharge from the IRF, which were then used to calculate the Montebello Rehabilitation Factor Score (MRFS), a measure of relative gain in function. Descriptive statistics and simple linear regression analyses were conducted using SPSS version 24. Results: Regression analyses indicated that greater daytime sleep duration was predictive of greater nighttime sleep duration on both days (p<0.05). There was a trend toward significance in the ability of greater nighttime sleep duration to predict better motor MRFS on both days (p=0.08). Greater nighttime sleep duration predicted cognitive MRFS on day 2 (p=0.01) but not on day 3 (p=0.13). Daytime sleep duration did not predict either cognitive or motor MRFS (p>0.05). Conclusions: Findings indicate that subjects who slept more during the daytime hours also slept more during the nighttime hours. Greater nighttime sleep duration trended towards predicting better motor functional recovery, as assessed by motor MRFS. Of interest, daytime sleep duration was not predictive of functional recovery, though actigraphy’s ability to distinguish sleep from sedentary behavior is disputable. Clinical Relevance: Unlike previous research indicating daytime sleep may disrupt nighttime sleep in healthy adults, our findings suggest that greater daytime sleep is predictive of greater nighttime sleep in this sample population post-stroke or TBI. Increased sleep altogether may be associated with damage to brain nuclei and projections involved in wakefulness. Daytime sleep architecture may also differ in this patient population, and daytime sleep may not dissipate the homeostatic pressure for sleep adequately. Providers and therapists should consider the differing effects of daytime sleep on nighttime sleep, and the potential for nighttime sleep to improve motor outcomes in patients post-stroke or TBI.

Clinical Institute

Neurosciences (Brain & Spine)




Sleep Medicine