ORIGINAL ARTICLE—CME
Bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors: An ecological momentary assessment study
Stephen C. L. Lau PhD,
Martica L. Hall PhD,
Lauren Terhorst PhD,
Elizabeth R. Skidmore PhD,
Corresponding Author
Stephen C. L. Lau PhD
Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
Correspondence
Stephen C. L. Lau, Program in Occupational Therapy, Washington University School of Medicine, 4480 Clayton Ave, St. Louis, MO 63110, USA.
Email: [email protected]
Search for more papers by this authorMartica L. Hall PhD
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorLauren Terhorst PhD
Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorElizabeth R. Skidmore PhD
Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorStephen C. L. Lau PhD,
Martica L. Hall PhD,
Lauren Terhorst PhD,
Elizabeth R. Skidmore PhD,
Corresponding Author
Stephen C. L. Lau PhD
Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
Correspondence
Stephen C. L. Lau, Program in Occupational Therapy, Washington University School of Medicine, 4480 Clayton Ave, St. Louis, MO 63110, USA.
Email: [email protected]
Search for more papers by this authorMartica L. Hall PhD
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorLauren Terhorst PhD
Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorElizabeth R. Skidmore PhD
Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorAnswer questions and earn CME credit.
Abstract
Introduction
Sleep plays a critical role in daily functioning and stroke recovery but receives little attention in stroke rehabilitation. Sleep disturbances are linked to affective and cognitive impairments, but temporal associations between sleep and affect and cognitive symptoms are less clear. Understanding these temporal associations may inform new directions in intervention and prevention to support continued stroke recovery.
Objective
To examine the bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors.
Design
A secondary analysis of a longitudinal observational study involving 7 days of ecological momentary assessment (EMA), during which participants completed eight EMA surveys and a sleep diary per day. Multilevel modeling was used to analyze data.
Setting
Community.
Participants
Community-dwelling stroke survivors (N = 40).
Interventions
Not applicable.
Main Outcome Measures
EMA measures of depressed affect, cheerful affect, and cognitive symptoms. Sleep quality and duration as measured using a sleep diary.
Results
Between-person sleep quality was negatively associated with next-day depressed affect (B = −.16; p = .028) and positively associated with next-day cheerful affect (B = .63; p < .001). Inversely, between-person depressed affect was negatively associated with next night sleep quality (B = −.77; p = .015), and vice versa for cheerful affect (between-person: B = .45; p < .001; within-person: B = .09; p = .008). Long sleep (>9 hours) was positively associated with next-day cognitive symptoms (B = .13; p = .002), whereas cognitive symptoms were associated with a higher odds of long sleep the following night (odds ratio [OR] = 0.25; p = .047).
Conclusions
This study identified the bidirectional associations of sleep with affect and cognitive symptoms in the context of the everyday life of stroke survivors. The findings suggest that interventions addressing sleep quality and duration may impact affect and cognitive symptoms, and vice versa.
CONFLICT OF INTEREST STATEMENT
Authors report no conflict of interest.
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