Disorders of sleep and wake in patients after subarachnoid hemorrhage

• Published in: Stroke (1970) Vol. 36; no. 3; pp. 578 - 582
• Main Authors: SCHUILING, Wouter J, RINKEL, Gabriël J. E, WALCHENBACH, Rob, DE WEERD, Al W
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-03-2005
• Subjects: Biological and medical sciences; Drug addictions; Electromyography - methods; Female; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Neurology; Polysomnography - methods; Prospective Studies; Quality of Life; Sleep Wake Disorders - etiology; Subarachnoid Hemorrhage - complications; Surveys and Questionnaires; Toxicology; Vascular diseases and vascular malformations of the nervous system; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Wakefulness - physiology; Human; Stroke; Nervous system diseases; Subarachnoid hemorrhage; Sleep disorder; Cardiovascular disease; Cerebral disorder; Vascular disease; sleep; Central nervous system disease; Neurological disorder; quality of life; Cerebrovascular disease; outcome
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000154862.33213.73

To determine the frequency and severity of disorders of sleep and wake and their relation to the quality of life (QoL) in patients who have survived an episode of subarachnoid hemorrhage (SAH).
In a prospectively collected, consecutive series of 89 patients, 83 patients completed validated and frequently used questionnaires for the assessment of disorders of sleep and wake (SDL and Epworth Sleepiness Score) at least 1 year (range, 1 to 3.4 years) after the SAH. We used the modified Rankin scale for functional outcome and Short Form 36 (SF-36) to assess QoL. We related the occurrence of severe problems with sleep (insomnia or excessive daytime sleepiness score or both > or =3 on SDL) to functional outcome and to the QoL scores and compared the latter scores with data from a Dutch reference population. In a subset of 20 patients with severe problems with sleep, we performed polysomnographic and actigraphic studies at home during 48 hours.
Twenty eight (34%) patients had severe problems with sleep. Frequently reported problems are initiating (25%) or maintaining (31%) sleep, difficulty returning (28%) asleep, tiredness (31%), and excessive sleepiness during the day (6%). QoL was considerably reduced in patients with severe problems with sleep. During the sleep monitoring studies, severe sleep fragmentation, sleep apnea, restless legs syndrome/periodic limb movement disorder, or a combination of these disorders of sleep and wake occurred in 19 of 20 patients.
Many patients who have survived an episode of SAH have disorders of sleep and wake, which are related to the QoL.