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 &lt;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.本研究旨在评估急性缺血性脑卒中老年患者中食欲素1（Hcrt-1）与卒中后抑郁（PSD）的潜在关联，以及卒中后睡眠质量是否在二者关联中发挥中介作用。研究对急性缺血性脑卒中老年患者采用自填式问卷开展调查，采集入院时的脑脊液（CSF）样本以检测Hcrt-1水平。采用Bootstrap法探究Hcrt-1与PSD之间的关联，若95%置信区间（CI）不包含0，则认为该中介效应具有统计学意义。结果显示，老年患者中PSD与卒中后睡眠质量不佳的患病率分别为38.73%与42.16%；合并PSD及卒中后睡眠质量不佳的患者，其脑脊液Hcrt-1水平显著降低。同时，Hcrt-1、卒中后睡眠质量与PSD三者间均存在显著相关性（P<0.01）。中介分析证实，卒中后睡眠质量在Hcrt-1与PSD的关联中充当中介变量；脑脊液Hcrt-1对PSD的影响通过卒中后睡眠质量介导，中介效应占比达32.25%。卒中后睡眠质量可能部分介导脑脊液Hcrt-1水平与PSD的关联。本研究结果揭示了Hcrt-1与PSD之间潜在的生物学与行为学机制。