Insomnia and Sleep Disturbance in Stroke Survivors: A Meta-Analysis of Prevalence, Risk Factors, and Recovery Outcomes in Ischemic and Hemorrhagic Stroke Survivors.

Post-stroke sleep disturbance/insomnia is a prevalent but under-recognized complication that impairs recovery and the quality of life in stroke survivors. This meta-analysis aims to determine the prevalence of sleep disturbance/insomnia after stroke, compare sleep disturbance/insomnia rates between ischemic and hemorrhagic stroke patients, evaluate demographic and regional influences, and assess the impact of comorbidities such as anxiety, depression, and cardiovascular conditions on post-stroke sleep disturbance/insomnia. This meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024622432). A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library to identify observational studies reporting sleep disturbance or insomnia among adult stroke survivors. Data on stroke subtypes, sleep disturbance/insomnia prevalence, risk factors, and diagnostic methods were extracted. Quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses evaluated variations by sleep disturbance/insomnia definition, age, stroke type, follow-up duration, and region. Thirteen studies encompassing 6,109 stroke survivors were included. Women, patients with anxiety, depression, or heart disease, showed significantly higher odds of post-stroke sleep disturbance/insomnia. Subgroup analyses suggested that sleep disturbance/insomnia during later follow-up (>3 months) was more pronounced. Post-stroke sleep disturbance/insomnia is influenced by psychological and clinical factors, with heightened vulnerability in female patients, anxiety, depression, and existing heart conditions. These findings support the integration of sleep assessments and targeted interventions into stroke rehabilitation to enhance recovery outcomes.