Sleep Quality Status and its Associated Factors among the Person with Stroke at a Rehabilitation Center in Bangladesh: A Cross-Sectional Study

Abstract

Background: Sleeping is a crucial physiological state that enhances physical and mental health, memory, metabolism, and immunity. Sleep disturbances are prevalent among stroke survivors, significantly impacting their recovery and quality of life. Aim: To measure sleep quality status and associated factors among the person with stroke at a rehabilitation center in Bangladesh. Methods: The study used a cross-sectional design to conduct a face-to-face survey with 152 stroke patients’ where was 74.3% male and 25.7% female who received outpatient intervention from the Occupational Therapy Department at the Centre for the Rehabilitation of Paralysed (CRP). Standardised questionnaires Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the sleep quality and patterns of stroke patients from the month before the data collection date. Statistical analysis was performed using the SPSS 26 version software, focusing on the associations between PSQI and demographic variables. Results: 71.7% (n=109) of participants reported experiencing poor sleep quality according to PSQI criteria. Among the 109 participants, 55.3% suffered from insomnia and the remaining 44.7% suffered from sleep-disordered breathing. Older age (61-70 years) was significantly associated with poor sleep, where male suffered more 68.8% rather than female 31.2%. Among participants was found an increase with insomnia, which was 3.43 times higher among those without insomnia (AOR=3.426, CI=1.886-160.705, P=.001). Morning alertness was also significantly associated with sleep quality, with tired participants having 2.7 times higher poor sleep compared to refreshed participants (AOR= 2.698, CI= .659-1.711, P= .020). Participants who faced upper limb pain were 0.83 less have poor sleep (AOR = 0.834, CI = 0.211-0.891, P = 0.023) than those with no pain. Comorbidities such as diabetes (P=.004), mental health issues (P=.016), immobility (P=.010), and shoulder subluxation (P=.049), Stress (P=.005), upper-limb pain (P=.021), and nocturnal bathroom visits (P=.011) were associated with poor sleep quality. Conclusion: Over two-thirds of stroke patients are suffering from sleep disturbances, insomnia and sleep-disorder breathing were the most common sleeping-related problems. Older age (61–70 years), male sex, waking up tired, diabetes, mental health problems, immobility, shoulder subluxation, upper-limb pain, stress, and frequent nocturnal bathroom visits associated with poor sleep. There were no associations with socio demographic factors, stroke characteristics (stroke type, lesion side and recurrence), lifestyle and environmental variables. Sleep assessment should be performed routinely (e.g., using the PSQI). Management of pain, stress, depression, optimization of daytime naps, educate sleep hygiene routine, CBT-I and multidisciplinary care for comorbid conditions. Need to conduct larger sample and intervention-based studies after stroke. These findings suggest that clinical practice and national policy in Bangladesh need to include protocols for sleep management. Important components of this integration should focus on staff training, patient counselling, and the use of technologies such as sleep monitors and mobile applications. Keywords: Sleep, Stroke, Sleep disorder, Sleep issue, Sleep problem, sleep disturbance.