Identifying sleep targets to improve stroke outcomes

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Abstract Stroke is the leading cause of adult disability in the United States and the second leading cause of mortality worldwide. The impact of stroke goes well beyond visible disability. Patient-reported outcomes (PROs) are now recognized as critical assessments of post-stroke outcomes. Important PROs such as fatigue, depression, and pain affect approximately half of stroke survivors and predict post-stroke disability, higher burden of care, and worse physical health but the underlying mechanisms are poorly understood. Surprisingly, the contributions of poor or inadequate sleep to PROs including post-stroke fatigue and traditional stroke outcomes have not been well-studied but have direct implications for screening and treatment. This application represents an ancillary study to the highly successful, ongoing Brain Attack Surveillance in Corpus Christi (BASIC) Project (R01 NS38916), recently renewed through March 2024. In this population-based stroke surveillance study within a Texan bi-ethnic county, all acute ischemic stroke patients are interviewed and followed prospectively for 90- day outcomes, including a comprehensive set of PROs. This unique epidemiologic sample, with equal representation of non-Hispanic whites and Mexican Americans, allows for the exploration of effects of disrupted sleep on fatigue and stroke outcomes in general and specifically in Mexican Americans, a subgroup with higher stroke risk and worse stroke outcomes. This will be accomplished through application of state-of- the-art comprehensive but feasible portable polysomnography and the addition of measures of post-stroke fatigue to the BASIC Project. Incorporating polysomnography into our large, population-based stroke study significantly enhances the feasibility to obtain detailed sleep metrics in the stroke population. This study will represent the largest longitudinal study to-date of full polysomnography among stroke patients. These highly translational aims will examine in a systematic manner the physiologic insight and clinical utility provided by polysomnography in relation to traditional and more patient-relevant stroke outcomes. Identification of sleep measures associated with poor stroke outcomes will identify potential treatment targets for stroke recovery and a potential target to reduce an important ethnic health disparity.