Inflammation, sleep-circadian disruption, and neuropsychiatric recovery after stroke: Mechanisms and integrated interventions for post-stroke depression and anxiety

Table 2 Phenotype-based integrated intervention strategies for post-stroke mood-sleep-circadian dysregulation

Dominant phenotype	Clinical clues	Immediate clinical priority	Integrated management
Insomnia-dominant	Difficulty initiating or maintaining sleep, early awakening	Exclude pain, nocturia, medication effects, and major environmental disruption	Sleep hygiene, stroke-adapted CBT-I, pain/nocturia control, nighttime environment optimization
Sleep-disordered breathing phenotype	Snoring, witnessed apnea, daytime sleepiness, resistant fatigue	Confirm respiratory risk and arrange formal sleep evaluation	Sleep medicine referral, CPAP if appropriate, vascular risk management
Circadian-disruption phenotype	Excessive daytime napping, nighttime wakefulness, low daytime activity	Restore daytime light exposure and regular activity timing	Morning light exposure, regular wake time, structured rehabilitation schedule, reduce evening light
Anxiety-hyperarousal phenotype	Fear of recurrence, bodily vigilance, panic-like symptoms, nocturnal worry	Assess symptom severity and stabilize nocturnal hyperarousal	Psychoeducation, relaxation training, graded return to activity, sleep stabilization
Inflammatory-risk phenotype	High CRP/IL-6, infection, pain, obesity, diabetes, poor sleep	Identify infection or uncontrolled medical comorbidity	Treat infection/pain, metabolic control, activity promotion, mood and sleep treatment
Fatigue-dominant phenotype	Low energy, reduced participation, daytime sleepiness	Distinguish sleepiness, mood symptoms, and physical deconditioning	Activity pacing, rehabilitation adjustment, sleep/circadian care, mood management

CBT-I: Cognitive behavioral therapy for insomnia; CPAP: Continuous positive airway pressure; CRP: C-reactive protein; IL-6: Interleukin-6.