Table_1_Impact of Sleep Duration on Depression and Anxiety After Acute Ischemic Stroke.docx

Background: Abnormal sleep duration predicts depression and anxiety. We seek to evaluate the impact of sleep duration before stroke on the occurrence of depression and anxiety at 3 months after acute ischemic stroke (AIS).
Methods: Nationally representative samples from the Third China National Stroke Registry were used to examine cognition and sleep impairment after AIS (CNSR-III-ICONS). Based on baseline sleep duration before onset of stroke as measured by using the Pittsburgh Sleep Quality Index (PSQI), 1,446 patients were divided into four groups: >7, 6–7, 5–6, and <5 h of sleep. Patients were followed up with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) for 3 months. Poststroke anxiety (PSA) was defined as GAD-7 of ≥5 and poststroke depression (PSD) as PHQ-9 of ≥5. The association of sleep duration with PSA and PSD was evaluated using multivariable logistic regression.
Results: The incidences of PSA and PSD were 11.2 and 17.6% at 3 months, respectively. Compared to a sleep duration of >7 h, 5–6 h, and <5 h of sleep were identified as risk factors of PSA [odds ratio (OR), 1.95; 95% confidence interval (CI), 1.24–3.07; P < 0.01 and OR, 3.41; 95% CI, 1.94–6.04; P < 0.01) and PSD (OR, 1.47; 95% CI, 1.00–2.17; P = 0.04 and OR, 3.05; 95% CI, 1.85–5.02; P < 0.01), while 6–7 h of sleep was associated with neither PSA (OR, 1.09; 95% CI, 0.71–1.67; P = 0.68) nor PSD (OR, 0.92; 95% CI, 0.64–1.30; P = 0.64). In interaction analysis, the impact of sleep duration on PSA and PSD was not affected by gender (P = 0.68 and P = 0.29, respectively).
Conclusions: Sleep duration of shorter than 6 h was predictive of anxiety and depression after ischemic stroke.

背景：睡眠时长异常可预测抑郁与焦虑的发生。本研究旨在评估急性缺血性脑卒中（Acute Ischemic Stroke, AIS）发病前的睡眠时长对患者卒中后3个月抑郁及焦虑发生情况的影响。
方法：本研究采用第三次中国脑卒中登记研究（Third China National Stroke Registry）的全国代表性样本，开展急性缺血性卒中后认知与睡眠损害相关研究（CNSR-III-ICONS）。研究人员通过匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI）评估患者卒中发病前的基线睡眠时长，将1446例患者划分为四组：睡眠时长＞7小时、6~7小时、5~6小时及＜5小时。对所有患者进行为期3个月的随访，采用广泛性焦虑障碍量表7项版（General Anxiety Disorder-7, GAD-7）与患者健康问卷9项版（Patient Health Questionnaire-9, PHQ-9）评估其精神状态。将GAD-7评分≥5定义为卒中后焦虑（Poststroke Anxiety, PSA），PHQ-9评分≥5定义为卒中后抑郁（Poststroke Depression, PSD）。采用多因素logistic回归分析，评估睡眠时长与PSA、PSD之间的关联。
结果：随访3个月时，PSA与PSD的发生率分别为11.2%与17.6%。以睡眠时长＞7小时的组别为参照，睡眠时长5~6小时与＜5小时均被确认为PSA的危险因素[比值比（odds ratio, OR）=1.95，95%置信区间（confidence interval, CI）：1.24~3.07，P<0.01；OR=3.41，95%CI：1.94~6.04，P<0.01]，同时也是PSD的危险因素（OR=1.47，95%CI：1.00~2.17，P=0.04；OR=3.05，95%CI：1.85~5.02，P<0.01）；而睡眠时长6~7小时与PSA（OR=1.09，95%CI：0.71~1.67，P=0.68）及PSD（OR=0.92，95%CI：0.64~1.30，P=0.64）均无显著统计学关联。交互分析结果显示，睡眠时长对PSA与PSD的影响不受性别因素的调节（分别对应P=0.68与P=0.29）。
结论：缺血性卒中发病前睡眠时长不足6小时，可预测患者卒中后焦虑与抑郁的发生风险。