Study on the relationship between sleep–wake states and prognosis in patients with intracranial arterial stenosis and ischemic stroke

Objective To evaluate the influence of the sleep–wake state on the prognosis of patients with ischemic stroke. Methods Consecutive patients with intracranial ischemic stroke due to arterial stenosis were included (198 cases). The control group consisted of contemporaneous patients without cerebrovascular stenosis or any diagnosed cerebrovascular disease (77 cases). Collect the following variables of the patients, including the total recording time during the day and night, total sleep time, sleep latency, rapid eye movement (REM) sleep latency, wake time after falling asleep, light sleep stage (N1, N2 stage), deep sleep stage (N3 stage), and non-rapid eye movement (non-rapid eye movement) (NREM) sleep stage, rapid eye movement (REM) sleep stage, and stroke topography (anterior circulation and posterior circulation ischemic stroke). The primary outcome was the functional status at discharge, evaluated using the modified Rankin Scale (mRS): good prognosis (mRS ≤ 2) and poor prognosis (mRS > 2). Results In the regression analysis of prognostic influencing factors in patients with ACIS, it was concluded that an increase in daytime deep sleep time was associated with an increased possibility of adverse outcomes in patients with ACIS (OR = 1.026; 95% CI, 1.003–1.048, p = 0.024). In the regression analysis of prognostic influencing factors in patients with PCIS, it was concluded that during PCIS, the duration of deep sleep was longer (OR = 1.038; 95% CI, 1.001–1.077, p = 0.046) and the duration of nocturnal NREM staging was longer (OR = 1.010; patients with 95% CI, 1.000–1.020, p = 0.042) had a higher possibility of adverse outcomes. Conclusion The sleep–wake state of patients with intracranial artery stenoischemic stroke changes. The main characteristics are increased diurnal sleep, increased incidence of daytime sleep, and disordered sleep–wake phases. In patients with ACIS, the diurnal sleep–wake biological rhythm mainly characterized by poor daytime stability is unbalanced. The longer the duration of daytime deep sleep and nighttime NREM sleep, the higher the possibility of adverse outcomes in patients with intracranial artery stenotic ischemic stroke.