Sleep problems may adversely impact health-related quality of life, function, and participation during the first 12 months of stroke rehabilitation, according to study results published in Clinical Rehabilitation.

Previous studies reported that sleep has a major role in the acquisition of motor skills after stroke and that poor sleep quality is associated with worse outcomes. The goal of the current study was to assess the impact of self-reported sleep problems on recovery following stroke.

The researchers performed a secondary analysis of sleep-related data collected at 2, 6, and 12 months post-stroke from the Locomotor Experience Applied Post-Stroke ( Identifier: NCT00243919)  study. This was a phase III, single blind, randomized-controlled clinical trial of adult patients during the first year following stroke.

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The participants reported sleep problems at each point and the impact of sleep on their function. In addition, they completed the Stroke Impact Scale to assess health-related quality of life after stroke.

Data collected from 408 subjects (mean age 62.0 years; 55% men) was used for the study, including 327 (80%) patients with a history of ischemic stroke and 76 (19%) patients with that of a hemorrhagic stroke. Data was available from 380 participants at 6 months and from 360 subjects at 12 months.

A total of 98 participants (24%) reported the presence of sleep problems at 2 months, and this rate remained steady at 6 months (94 subjects, 25%) and at 12 months (83 subjects, 23%). Additionally, 10% of participants with sleep problems reported a moderate-to-quite-a-bit-of-impact on function at 2, 6 and 12 months.

Participants who reported having a “sleep problem such as insomnia” that impacted their function had worse function in limb strength, memory and thinking, mood and ability to control emotions, communication, activities of daily living ability, mobility, hand function, and participation during the first year after stroke. However, there was no difference in full recovery.

The study had several limitations, including those associated with the use of self-reported data and lack of objective evidence for sleep disorder. Researchers had not determined whether patients who reported sleep problems were subsequently assessed, diagnosed, or if they received treatment during the study. Other limitations included the study’s cross-sectional design and missing data on sleep disorder diagnoses preceding stroke.

“Our findings here,” concluded the researchers, “indicate that sleep problems may degrade health-related quality of life, function, and participation during the subacute and chronic stages of post stroke recovery.”


Fulk G, Duncan P, Klingman KJ. Sleep problems worsen health-related quality of life and participation during the first 12 months of stroke rehabilitation [published online, June 30, 2020]. Clin Rehabil. doi:10.1177/0269215520935940