Thalamic Stroke and Sleep Study: Sleep-Wake, Autonomic Regulation, and Cognition

BACKGROUND: Thalamic stroke (TS) often presents with complex clinical manifestations, including sleep-wake disturbances, cognitive deficits, and autonomic dysregulation, yet the interaction between these functional alterations remains poorly understood. We aimed to investigate these interactions in a case-control lesion study. METHODS: Patients with acute TS and no-stroke controls were included prospectively in this study. The data were collected from June 2020 to September 2022 at the stroke unit or sleep laboratory of the Inselspital (Bern). Sleep-wake variables (questionnaires, actigraphy, polysomnography including electroencephalography-based sleep macroarchitecture and microarchitecture, and analysis of electroencephalography spectral power), nocturnal heart rate variability, and cognition (5 tests: processing speed, attention, working memory, visual memory, and verbal memory) were assessed at study inclusion (within 5 days poststroke for patients with stroke). RESULTS: Data from 16 patients with TS and 32 control volunteers were analyzed. All patients with stroke had lesions of the ventral nuclei, while 9 of 16 patients with stroke also had lesions in the mediodorsal nucleus (1 bilateral). TS was characterized by long sleep duration and high nocturnal heart rate variability with parasympathetic dominance. The alterations in sleep electroencephalography included a decrease in cyclic alternating pattern index, slow spindle density, the quantity of isolated sawtooth wave segments, and electroencephalography spectral power predominantly affecting the alpha band. The mediodorsal lesions were associated with a decrease in sleep spindle amplitude and slow wave amplitude and with an increase in phasic rapid eye movement sleep. Furthermore, patients with TS had deficits in processing speed, working memory, and verbal memory, mostly pronounced in patients with mediodorsal lesions. In a combined data set, multiple correlations were observed between sleep-wake, autonomic, and cognitive parameters, many of which depended on the presence of a TS. CONCLUSIONS: These findings emphasize the role of the thalamus in the regulation of sleep-wake, autonomic, and cognitive functions and their interactions and provide the theoretical basis for the therapies targeting the thalamus.