Supporting data for “Sleep Dysfunction, Cerebral Small Vessel Disease Burden and Cognitive Impairment in Patients with Stroke"

Stroke is the second leading cause of death and a major cause of disability worldwide. Sleep dysfunction, including obstructive sleep apnea (OSA) and poor sleep quality, are prevalent but often neglected in stroke patients. Although it is estimated that over 70% of stoke patients suffer from OSA, and up to 40% experience insomnia following stroke, only around 6% are offered an official sleep test. Cerebral small vessel disease (CSVD) and cognitive impairment are commonly encountered in stroke patients. CSVD contributes to 25% of stroke and 45% of dementia globally; while up to 50% of stroke patients experience neurocognitive disorders. To date, little is known about the determinants of high OSA prevalence in the stroke population, and the relationship of sleep dysfunction with CSVD burden or cognitive impairment following stroke.

The studies described in my PhD thesis have four key aims: 1) to systematically assess the prevalence and determinants of OSA in stroke population; 2) to explore the association of OSA status with CSVD burden in stroke patients; 3) to investigate the association of sleep quality with CSVD burden in stroke patients; and 4) to evaluate the impact of sleep disturbances on the longitudinal cognitive trajectory following stroke.

  

I prospectively recruited patients with newly diagnosed transient ischemic attack (TIA) or minor stroke (National Institute of Health Stroke Scale <7) from the Acute Stroke Unit and TIA/Minor Stroke Clinics of Queen Mary Hospital, Hong Kong from 2018 to 2021. I collected and analyzed clinical, neuroimaging, sleep (sleep questionnaires and actigraphy], and cognitive data at baseline, and repeated sleep questionnaires and cognitive assessments at one year visit. I also performed a home sleep apnea test (HSAT) within one year for patients who were eligible and willing to join the HSAT sub-study. I coded all the brain magnetic imaging resonance (MRI) scan, interpreted for CSVD burden including recent small subcortical infarct, lacunes, cerebral microbleeds, white matter hyperintensities, enlarged perivascular spaces and brain atrophy. I also analyzed all the HSAT and actigraphy data, extracted oxygen desaturation indices quantifying nocturnal hypoxemia, and obtained the subjective and objective sleep measurements from the PSQI and actigraphy, respectively.

The databases involved in this PhD project consist of the aforementioned clinical personal data, medical history, neuroimgaing, cognitive and sleep assessments of stroke/transient ischemic attack patients (IRB reference number: UW18-361).