Prevalence of post-stroke poor sleep quality: a meta-analysis of Pittsburgh Sleep Quality Index results

Objective: To assess the prevalence of post-stroke poor sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following the PICO framework, a systematic search was conducted in PubMed, CINAHL, Cochrane Library, and Web of Science for relevant cohort, case-control, and cross-sectional studies published up to October 2024. The retrieved literature was then meta-analyzed using Stata 13.0 software. Results: Eighteen studies were reviewed, showing a total poor sleep quality prevalence of 55% (95%CI = 0.47 to 0.62) and a PSQI score is 8.12 (95%CI = 6.71 to 9.53). Compared to normal people, stroke patients sleep onset latency (SL) was prolonged by 1.36 min (95%CI = 0.82 to 1.90), sleep efficiency (SE) decreased by 1.48% (95%CI = -0.20 to -0.92), and periodic leg movements per hour of sleep (PLMI) increased by 1.07 per hour (95%CI = 0.56 to 1.59). Subgroup analysis showed that, compared with hemorrhagic stroke patients, ischemic stroke patients had higher incidence of poor sleep quality at 52% (95%CI = 0.24 to 0.86); the incidence of poor sleep quality was 59% (95%CI = 0.49 to 0.70) higher in chronic stroke patients compared to acute and subacute stroke patients; the incidence of poor sleep quality was 61% (95%CI = 0.51 to 0.71) higher in community stroke patients than in hospitalized stroke patients; and the incidence of poor sleep quality was 59% (95%CI = 0.58 to 0.61) higher in stroke patients in developing countries than those in developed countries. Conclusion: Current evidence suggests that quality of sleep worsens after a stroke, with symptoms being widespread. Factors such as stroke type, stroke phase, clinical setting, and research region can all impact sleep quality after stroke. These findings underscore the importance of monitoring sleep quality in these populations and implementing appropriate preventive and interventional strategies. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420251161167.