Association between sleep-disordered breathing and post-stroke fatigue in patients with ischemic stroke

Objectives: Post -stroke fatigue (PSF) is common and often disabling. Sleep -disordered breathing (SDB) is highly prevalent among stroke survivors and can cause fatigue. We explored the relationship between SDB and PSF over time. Materials and Methods: Ischemic stroke (IS) patients within the BASIC project were offered SDB screening with a well -validated cardiopulmonary sleep apnea test at 0, 3-, 6-, and 12 -months post -stroke. The primary exposure was the respiratory event index (REI; sum of apneas plus hypopneas per hour). The primary outcome was PSF, measured by the SF -36 vitality scale. Associations between REI and PSF were evaluated using linear regression including time-by-REI interactions, allowing the effect of REI to vary over time. Results: Of the 411 IS patients who completed at least one outcome interview, 44 % were female, 61 % Mexican American (MA), 26 % non -Hispanic white, with a mean age of 64 (SD 10). Averaged across timepoints, REI was not associated with PSF. In a time -varying model, higher REI was associated with greater PSF at 3 -months (beta = 1.75, CI = 0.08, 3.43), but not at 6- or 12 -months. Across timepoints, female sex, depressive symptoms, and comorbidity burden were associated with greater PSF, whereas MA ethnicity was associated with less PSF. Conclusions: Higher REI was associated with modestly greater PSF in the early post -stroke period, but no association was observed at 6 months and beyond. SDB may be a modest modifiable risk factor for early PSF, but its treatment is unlikely to have a substantial impact on long-term PSF. MA ethnicity seems to be protective against PSF.