To determine factors associated with sleep disturbance after hemorrhagic stroke. 

Identification of factors associated with sleep disturbance after hemorrhagic stroke is necessary to optimize recovery.

We prospectively identified patients between January 2015 and February 2021 with non-traumatic hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) and telephonically assessed sleep disturbance at 3-months and 12-months using the Quality of Life in Neurological Disorders sleep disturbance inventory. We examined the relationship between sleep disturbance (T-score >50) at 3-months and preclinical social and neuropsychiatric history, systemic and neurological illness severity, complications during hospitalization and readmission. We then compared sleep disturbance at 3-months and 12-months.

70 patients completed the 3-month call; 18 (26%) had sleep disturbance. There was a significant relationship between sleep disturbance at 3-months and unemployment prior to admission (p=0.043), lower Glasgow Coma Scale (GCS) score on admission (p=0.021), higher NIHSS on admission (p=0.041) and infection while hospitalized (p=0.036). On multivariate analysis using employment status, GCS score, infection and neuropsychiatric history, sleep disturbance at 3-months was only related to unemployment prior to admission (OR 3.57 (95% CI 1.03-12.38), p=0.045). There was no significant relationship between sleep disturbance at 3-months and patient demographics, social or neuropsychiatric history, premorbid mRS score, bleed type, admission APACHE II score, hospital or ICU length-of-stay, days on a ventilator or readmission. There were 32 (46%) patients who completed the 12-month follow-up call. There was moderate agreement (κ=0.503) between sleep disturbance at 3-months and 12-months; 21 (66%) patients had no sleep disturbance, 5 (16%) had sleep disturbance at both markers, 5 (16%) had sleep disturbance at 3-months which improved at 12-months and 1 (3%) developed a new sleep disturbance at 12-months.  

Unemployment prior to admission may increase the risk of sleep disturbance after hemorrhagic stroke. Recognition of risk factors can be used to develop interventions to improve sleep for this population.