The relationship between fatigue and insomnia in ischemic stroke convalescence patients: the chained mediation effects of social support and anxiety

To analyze the mediating effects of social support and anxiety on the relationship between fatigue and insomnia in patients during the recovery phase of ischemic stroke. A random sampling method was employed to recruit 823 ischemic stroke patients admitted to the neurology departments of two tertiary hospitals in Jilin Province, China, between February 2023 and October 2024. The study assessed patients' fatigue severity, social support, emotional state, and insomnia status using the Fatigue Severity Scale (FSS), Social Support Rating Scale (SSRS),Self-Rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Spearman correlation analysis was used to explore the relationships among variables, and a mediation model was constructed using Model 6 of the SPSS PROCESS macro program. The median PSQI score of ischemic stroke patients during the recovery phase was 6 (interquartile range: 4,9), and the median FSS score was 26 (interquartile range: 20,33), indicating relatively mild fatigue and moderate sleep quality in this patient cohort. Fatigue severity was positively correlated with insomnia risk and anxiety but negatively correlated with social support. Anxiety was positively correlated with insomnia, while social support was negatively correlated with both insomnia and anxiety (P<0.001). Social support and anxiety exerted a chained mediating effect between fatigue and insomnia, accounting for 17.19% of the total effect. Fatigue not only directly predicts the risk of insomnia in patients recovering from ischemic stroke, but also predicts the risk of insomnia through the chain-mediated effects of anxiety and society. Therefore, effective fatigue management measures to enhance the level of social support and improve anxiety can effectively alleviate insomnia, promote the recovery process, and prevent the occurrence of secondary stroke. Trial registration date is January 2023, Number:CZDSFYLL2024-056-01.