Frequency and evolution of sleep-wake disturbances after ischemic stroke: A 2-year prospective study of 437 patients.

OBJECTIVE: In the absence of systematic and longitudinal data, this study prospectively assessed both frequency and evolution of sleep-wake disturbances (SWD) after stroke. METHODS: In 437 consecutively recruited patients with ischemic stroke or transient ischemic attack (TIA), stroke characteristics and outcome were assessed within the 1st week and 3.2 ± 0.3 years (M±SD) after the acute event. SWD were assessed by interview and questionnaires at 1 and 3 months as well as 1 and 2 years after the acute event. Sleep disordered breathing (SDB) was assessed by respirography in the acute phase and repeated in one fifth of the participants 3 months and 1 year later. RESULTS: Patients (63.8% male, 87% ischemic stroke and mean age 65.1 ± 13.0 years) presented with mean NIHSS-score of 3.5 ± 4.5 at admission. In the acute phase, respiratory event index was >15/h in 34% and >30/h in 15% of patients. Over the entire observation period, the frequencies of excessive daytime sleepiness (EDS), fatigue and insomnia varied between 10-14%, 22-28% and 20-28%, respectively. Mean insomnia and EDS scores decreased from acute to chronic stroke, whereas restless legs syndrome (RLS) percentages (6-9%) and mean fatigue scores remained similar. Mean self-reported sleep duration was enhanced at acute stroke (month 1: 07:54 ± 01:27h) and decreased at chronic stage (year 2: 07:43 ± 01:20h). CONCLUSIONS: This study documents a high frequency of SDB, insomnia, fatigue and a prolonged sleep duration after stroke/TIA, which can persist for years. Considering the negative effects of SWD on physical, brain and mental health these data suggest the need for a systematic assessment and management of post-stroke SWD.

Stability in the choice of method during the period preceding a suicide attempt and in attempt repeaters

Background and Objectives: Understanding the mental processes preceding a suicidal act is important for the potential to intervene. This study investigates stability and possible changes of suicide methods considered during the time immediately preceding a suicide attempt. Methods: Patients who had attempted suicide were interviewed shortly thereafter with regard to whether there was a change in the conception of the method to be used during the period preceding the attempt. In addition, the course of methods applied in previous suicide attempts was assessed in attempt repeaters. Results: In total, 130 patients were included. In 63.1% one method only was envisaged during the entire suicidal crisis, in 26.9% the initial and the actual method differed. Stability rate was higher in those older than 40 years, if the duration of the suicidal crisis was less than or equal to 60 minutes and if a non violent suicide method was initially intended. Of repeaters, 46.5% used the same method in all recorded attempts. Use of a non-violent method in the first suicide attempt predicted method stability in subsequent attempts. Conclusions: Focusing on one single suicide method during the time immediately preceding a suicide attempt is common. Reduced flexibility to rapidly switch mentally to another method may contribute to explain the effectiveness of limiting access to suicide means for suicide prevention (AU)

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