The role of sleep quality in the association between hypocretin-1 and depression in elderly patients with acute ischemic stroke

This study aims to evaluate the possible association between Hcrt-1 and post-stroke depression (PSD) in elderly patients with acute ischemic stroke, and whether post-stroke sleep quality mediated such links. A self-report questionnaire was administered to elderly individuals with acute ischemic stroke. Cerebrospinal fluid (CSF) samples were taken to assess the levels of Hcrt-1 at admission. A bootstrapping approach was performed to explore the relationship between Hcrt-1 and PSD. The mediator was considered significant if the 95% confidence interval (CI) did not include 0. The prevalence of PSD and poor post-stroke sleep quality was 38.73% and 42.16% among elderly patients. The levels of CSF Hcrt-1 were significantly lower in patients with PSD and poor post-stroke sleep quality. Meanwhile, there were significant correlations among Hcrt-1, post-stroke sleep quality, and PSD (P <0.01). Mediation analysis identified post-stroke sleep quality as medicator in the association between Hcrt-1 and PSD. The influence of CSF Hcrt-1 on PSD was mediated by post-stroke sleep quality, which accounted for 32.25%. Post-stroke quality of sleep might partially mediate the association of cerebrospinal fluid levels of Hcrt-1 with PSD. These results highlight the biological and behavioral mechanisms potentially linking Hcrt-1 to PSD.