Trajectories of sleep disturbances in the subacute phase after stroke: a longitudinal actigraphy study

Abstract Background: Sleep disturbances are common after stroke and may negatively impact recovery and quality of life. However, monitoring sleep parameters over time with objective measures remains underreported. Objective: To investigate longitudinal changes in actigraphy-derived sleep parameters from the subacute to later stages after stroke. Methods: This longitudinal observational study included 18 individuals with stroke who completed seven-day wrist-actigraphy monitoring at baseline and at the most distal valid follow-up assessment obtained more than three months after stroke. The median interval between assessments was 161 days (IQR 102.3–194.0). Time in bed, total sleep time, sleep latency, sleep efficiency, wake after sleep onset (WASO), and number of awakenings were compared using paired t-tests. Mean paired differences, 95% confidence intervals (CIs), and Cohen’s d effect sizes were calculated. Results: No statistically significant longitudinal changes were detected. Mean changes were − 0.12 h for time in bed (95% CI − 0.73 to 0.49), − 0.05 h for total sleep time (95% CI − 0.59 to 0.50), − 7.93 min for sleep latency (95% CI − 19.55 to 3.69), − 0.36% points for sleep efficiency (95% CI − 4.19 to 3.48), 3.63 min for WASO (95% CI − 9.22 to 16.48), and 0.43 for number of awakenings (95% CI − 0.74 to 1.59). Effect sizes were small, and exploratory individual-level analysis showed increased sleep efficiency in 10 participants and decreased sleep efficiency in 8. Conclusion: The analysis showed no statistically significant changes in sleep patterns between the subacute phase and the follow-up. While sleep metrics remained outside normal ranges at both time points, the small and heterogeneous sample, along with wide confidence intervals, prevents any definitive conclusions about long-term trends or causes.