The role of sleep in neurorehabilitation processes in subacute stroke patients: A longitudinal observational study

Introduction: Sleep plays a crucial role in cognitive functioning, emotional regulation, and physical recovery, all of which are essential components of the rehabilitation process for stroke survivors. Understanding the complex interplay between stroke rehabilitation and sleep is essential for optimizing treatment strategies and enhancing patient outcomes. The present study investigated sleep characteristics and rehabilitation outcomes to explore their relationship in patients recovering from subacute stroke. Method: Eighteen patients (11 males; 66.9 ± 11.6 years) in a poststroke rehabilitation program were enrolled. This longitudinal observational study (2 weeks) employed self-reported sleep questionnaires (Pittsburgh Sleep Quality Index, PSQI; Insomnia Severity Index, ISI; Epworth Sleepiness Scale, ESS) administered at the initial phase (T0). Prospective sleep and rehabilitation measures were longitudinally collected using Pittsburgh Rehabilitation Participation Scale (PRPS), wrist actigraphy (ActiWatch) and sleep diaries. Functional independence (Barthel Index), motor performance (Nine-Hole Peg Test, NHPT; 10 Meter Walk Test, 10MWT) and motor imagery (Imagery Performance Index, IPI) were evaluated at T0 and at the end of the twoweek protocol (T1). Comparison analyses (t-test or Wilcoxon) and analysis of variance (one-way ANOVA) were conducted to observe any variation over the observation period. Further, correlation analyses (Pearson or Spearman correlations) were performed to investigate the relationship between rehabilitation outcomes and sleeprelated aspects. Results: Significant improvements were observed in Barthel Index (p < 0.001), and motor performance (NHPT, 10MWT) (p = 0.02) from T0 to T1. The correlation analyses showed, consistent with the hypotheses, a relationship between better motor performance and higher level of independence (r =  0.66; p = 0.03) and participation (r =  0.63; p = 0.04). Finally, we observed worse motor performance in patients with more severe insomnia symptoms (r =  0.47; p = 0.04), and a greater degree of independence negatively correlated with the time spent sleeping (r =  0.73; p < 0.001). Conclusion: In this study it was highlighted that independence and participation correlate with motor performance, and that some sleep measures correlate with the level of patient autonomy and rehabilitation outcomes. This underscores the need to consider sleep characteristics in these patients to establish more effective rehabilitation protocols.