# Age-Related Variations in Sleep Duration and Quality Before, During, and After Stroke Among Hospitalised Stroke Patients

## TL;DR

This study examines how sleep changes before, during, and after stroke in hospitalized patients across different age groups.

## Contribution

The study provides new insights into sleep patterns in stroke patients and highlights the lack of significant age-related differences in sleep outcomes.

## Key findings

- Sleep duration and quality decreased during hospitalization and only partially recovered after discharge.
- Pre-stroke sleep duration averaged seven hours, dropping to 5.7-6.4 hours during hospitalization.
- Age-related differences in sleep duration were not statistically significant after adjusting for effect sizes.

## Abstract

Introduction

Stroke is a leading cause of mortality and long-term disability worldwide, with sleep disturbance increasingly recognised as both a risk factor and a determinant of recovery. Despite its clinical importance, sleep is seldom incorporated into routine stroke care. This study investigated age-related variations in sleep duration and quality before stroke, during hospitalisation, and after discharge.

Methods

A retrospective cohort study was conducted at Wrexham Maelor Hospital, North Wales, including 224 stroke patients admitted between March 2024 and March 2025. Stroke admissions were identified from the Sentinel Stroke National Audit Programme, with additional demographic and clinical data retrieved from electronic records. Sleep characteristics were assessed via structured questionnaires covering pre-stroke, admission, and post-discharge phases. Outcomes included average sleep duration (hours) and subjective quality (4-point scale), which were analysed using repeated measures ANOVA.

Results

Across all age groups, sleep duration and quality declined significantly during hospitalisation and showed partial recovery post-discharge. Pre-stroke sleep duration averaged approximately seven hours, dropping to 6.1 hours in younger patients, 6.4 hours in middle-aged patients, and 5.7 hours in older adults during admission. Sleep quality fell from ~3.0 pre-stroke to 2.1-2.5 during admission. Post-discharge, both measures improved but did not fully return to pre-stroke levels. Between-group ANOVAs revealed no statistically robust age-related differences in sleep duration, as p-values were consistently greater than 0.05 across groups. The only exception was observed in the 18-49 age group for pre-stroke sleep duration, where a statistically significant difference emerged. However, adjusted effect size estimates (ε² and ω²) were consistently near zero, indicating that the apparent significance may be inflated. These corrections suggest that the observed difference is unlikely to reflect a meaningful or clinically important effect, despite the large raw η² values reported.

Conclusion

Hospitalisation for stroke was associated with marked reductions in both sleep duration and quality across all age groups, with only partial recovery observed following discharge. However, these differences did not reach statistical significance. These findings underscore the importance of incorporating systematic evaluation and targeted interventions for sleep disturbances into comprehensive stroke care pathways, in order to optimise recovery and long-term patient outcomes.