Study on the sleep-wake circadian rhythm and phenotypic characteristics in the acute phase of hemorrhagic stroke.

OBJECTIVE

To investigate the sleep-wake circadian rhythm and phenotypic characteristics in patients with acute intracerebral hemorrhage (ICH), and to explore the relationship and potential mechanisms between sleep-wake phenotypes and circadian rhythm disruption.

METHODS

A retrospective analysis was conducted on 100 patients with acute ICH admitted to Kailuan General Hospital between January 2020 and December 2024, along with 67 age- and sex-matched hospitalized controls. Sleep parameters during the daytime (06:00-18:00) and nighttime (18:00-06:00) were collected using a mattress-based sleep monitoring system. Circadian rhythm indices-including interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA)-as well as sleep phenotypic features were evaluated.

RESULTS

Compared with the control group, patients with ICH exhibited significantly disrupted circadian rhythms, characterized by reductions in IS, IV, and RA (all p < 0.05). Significant alterations in sleep-wake states were observed in both daytime and nighttime periods among ICH patients. These included prolonged/increased durations and proportions of light sleep, deep sleep, NREM sleep, REM sleep, and sleep efficiency, along with shortened/decreased sleep latency, REM latency, and proportion of NREM sleep (all p < 0.05). Phenotypic analysis revealed a significantly higher prevalence of excessive daytime sleep, increased total sleep across 24 h, and reversed sleep-wake cycles in the ICH group (all p < 0.05). Regression analysis indicated that reduced IS was significantly associated with reversed sleep-wake cycles (OR = -5.831; 95% CI,: -12.577 ~ -1.350).

CONCLUSION

Acute hemorrhagic stroke is associated with excessive sleepiness, disrupted sleep architecture, and weakened circadian rhythms. These disturbances may impair recovery and long-term outcomes, underscoring the need for rhythm-based biomarkers and individualized interventions.