ABSTRACT NUMBER: ESOC2026A1212 PRE-STROKE SLEEP SYMPTOMS AND STROKE OUTCOME

Abstract Background and aims Sleep disturbances are common in patients with stroke, yet the prognostic relevance of pre-stroke sleep symptoms remains poorly established. We examined associations between self-reported pre-stroke sleep symptoms and neurological and functional status at admission and follow-up. Methods This secondary analysis of two prospective studies included 133 patients (median age 70 years; 37% women) with acute stroke or TIA. Patients completed a structured 16-item binary sleep symptom questionnaire at admission (median 2 days post-stroke) and follow-up (median 167 days). Admission responses reflected habitual pre-stroke sleep symptoms. Outcomes included the NIHSS and Barthel Index (BI). Associations were examined using linear and logistic regression models, adjusted for age and sex, and follow-up models were further adjusted for the corresponding baseline scores. Results At admission, pre-stroke hypnagogic hallucinations were associated with higher NIHSS (adj.β=2.1), lower BI (adj.β=-17.3), and increased odds of higher neurological deficit (NIHSS >4; adj.OR=3.18), while pre-stroke periodic limb movements during sleep (PLMS) were associated with increased odds of functional dependence (BI <80; adj.OR=2.4). At follow-up, pre-stroke PLMS, sleep-maintenance insomnia, and nocturia were each independently associated with higher NIHSS (adj. β range 0.9–1.3) and increased odds of higher neurological deficit (NIHSS >4; adj. OR range 7.85–9.45). Other sleep symptoms showed no significant associations. Conclusions In this exploratory secondary analysis, selected pre-stroke sleep symptoms were associated with greater impairment at admission and worse neurological recovery at follow-up. These findings suggest that pre-stroke sleep disturbances may serve as markers of adverse stroke outcomes and support early screening of sleep symptoms during stroke admission. Conflict of interest All authors have nothing to disclose