Gender,Inflammation,and Cognition Affect the Sleep Trajectories of Subarachnoid Hemorrhage Survivors

Abstract

Longitudinal trajectories of sleep in subarachnoid hemorrhage (SAH) survivors are not well known. We identified subgroups of SAH survivors based on distinct trajectories of sleep during the first 6 months post-SAH and compared sociodemographic characteristics, clinical characteristics, inflammatory biomarkers (Toll-like receptor 4, tumor necrosis factor [TNF]-α, interleukin [IL]-1β, and IL-6), and symptom-related characteristics (depression/anxiety, fatigue, sleep quality, and cognition) among the subgroups. We conducted a 6-month longitudinal study of 40 SAH survivors (mean age = 56.0). Multi-trajectory latent class growth analysis identified salient patient groupings based on the trajectories of sleep parameters—sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST)—assessed using actigraphy at 2, 3, and 6 months. Two trajectory groups were identified: Group 1 (n = 24; “high SE/short SOL/short WASO/adequate TST”) and Group 2 (n = 16; “low SE/long SOL/long WASO/insufficient TST”). The mean scores of all sleep parameters remained stable across months 2, 3, and 6 in both groups, except for SOL, which decreased in Group 2, but remained higher than that of Group 1. Individuals in Group 1 (vs. Group 2) were more likely to be female and had lower levels of TNF-α and IL-6 on days 3 and 4 post-SAH, respectively. Individuals in Group 1 (vs. Group 2) performed better on immediate memory, visuospatial/constructional ability, attention, and delayed memory tasks at 2 months. Distinct sleep trajectory groups were identified among SAH survivors; however, further studies with larger samples are needed to validate and better characterize these patterns.