Sleep problems in stroke patients: relationship with shoulder pain

Abstract

This study was designed to document the occurrence and the type of sleep problems in stroke patients and to examine the importance of shoulder pain in stroke in relation to sleep disturbances. Forty-six stroke patients were evaluated for the presence of sleep disturbances, general health problems (Nottingham Health Profile) and anxiety-depression (Hospital Anxiety Depression Scale) and compared with 47 age- and sex-matched subjects who had not had strokes. A four-item sleep questionnaire was used to assess different components of insomnia disorders through the previous month. The results showed that stroke patients had significantly more problems in initiating sleep than controls (p < 0.01). Other components of insomnia, difficulty in maintaining sleep or nonrestorative sleep did not differ between the two groups (p < 0.05). Factors found to be associated with poor sleep such as pain (p < 0.01), anxiety (p < 0.01) and depression (p < 0.01) were more common in the patient group but these did not otherwise result in a significant increase in all components of insomnia, probably because of the high level of benzodiazepine and tricyclic antidepressant intake amongst patients. Stroke patients with shoulder pain showed significantly more sleep disturbances (p < 0.01 ) and less general well-being (p < 0.05) than patients without shoulder pain. It is concluded that attention must be paid to shoulder pain and to ensuing sleep disturbances among stroke patients.