Actimetria do padrão sono-vigília de pacientes com Acidente Vascular Cerebral

Abstract

Stroke is a health condition that causes several motor and functional impairments. The aim of the study was to evaluate the sleep-wake pattern in stroke patients. The sample consisted of 10 patients (3 women and 7 men, mean age = 51 ± 6 years) and 10 healthy subjects (3 women and 7 men, mean age 52 ± 7 years). Participants were assessed by a sociodemographic and clinical evaluation sheet, National Institute of Health Stroke scale for neurologic evaluation, FuglMeyer scale for motor function evaluation, Pittsburgh Sleep Quality Index for sleep quality evaluation and sleep-wake pattern objective evaluation by Actigraphy (Actiwatch 2, Philips Respironics®, Andover, MA, USA) for 7 consecutive days. Data analysis was performed using the unpaired t'Student test and Pearson's correlation test. The findings revealed a significant difference between patients and healthy individuals in the IQSP, with patients presenting poor sleep quality (patients=6±4, healthy=4±2, p=0.044). Actigraphic analysis demonstrated that stroke patients showed lower level of activity both the wake phase (patients=142315±64367 counts, healthy=304392±88192 counts, p<0.0001) and the sleep phase (patients=3874±3279 counts, healthy=7812±4732; p<0.0001); longer sleep duration (patients=480±101 minutes, healthy=426±70 minutes, p=0.020); lower wake time (patients=896 ± 91 minutes, healthy=972±93 minutes, p=0.002). Additionally, it was verified that in relation to the variables of circadian rhythmicity that patients presented higher Interdaily Stability (IS) (patients=0.4±0.1, healthy=0.3±0.2, p=0.028), and higher Intradaily Variability (IV) (patients=0.7±0.1, healthy=0.6±0.1, p<0.001); lower values to the most active 10 hours (M10) (patients=32.3±11.7, healthy=62.6±14.9, p<0.0001) and to the least active 5 hours (L5) (patients=17.5±6.8, healthy=41.2±12.6, p<0.0001). We found a significant correlation between the IQSP and the activity level during wake phase (r=-0.32, p=0.007) and IQSP and IV (r=0.53, p=0.017). The results suggest that the activity level and fragmentation of the activity rhythm may alter the sleep-wake pattern and cause problems on sleep quality in stroke patients, which may be a temporal marker for the planning of therapeutic intervention during neurorehabilitation.