Zhao ZG, Qian C, Zhu HJ, Xu ZY. Sleep disturbance and inflammatory markers associated with post-stroke depression, anxiety, and cognitive impairment. World J Psychiatry 2026; 16(9): 119902 [DOI: 10.5498/wjp.119902]
Corresponding Author of This Article
Zhi-Yun Xu, Department of Emergency Medicine, The Second People’s Hospital of Nantong, No. 298 Xinhua Road, Chongchuan District, Nantong 226001, Jiangsu Province, China. xuzhiyun1059@163.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zhen-Guo Zhao, Cheng Qian, Zhi-Yun Xu, Department of Emergency Medicine, The Second People’s Hospital of Nantong, Nantong 226001, Jiangsu Province, China
Hai-Jiao Zhu, Department of Psychiatry, The Fourth People’s Hospital of Nantong, Nantong 226001, Jiangsu Province, China
Co-first authors: Zhen-Guo Zhao and Cheng Qian.
Author contributions: Zhao ZG and Qian C contributed to conceptualization, methodology, formal analysis, investigation, and writing the original draft; Zhu HJ was responsible for data curation, validation, and visualization; Xu ZY supervised the project, revised the manuscript, and administered the project. All authors have read and agreed to the published version of the manuscript. Zhao ZG and Qian C contributed equally to this work as co-first authors.
AI contribution statement: No AI tool was involved.
Supported by Scientific Research Project of Nantong Municipal Health Commission, No. MSZ2025049; and Nantong Social and Livelihood Science and Technology Program, No. MSZ2024093.
Institutional review board statement: This study was approved by the Institutional Review Board of The Second People’s Hospital of Nantong.
Informed consent statement: The Institutional Review Board waived the requirement for informed consent.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Zhi-Yun Xu, Department of Emergency Medicine, The Second People’s Hospital of Nantong, No. 298 Xinhua Road, Chongchuan District, Nantong 226001, Jiangsu Province, China. xuzhiyun1059@163.com
Received: April 10, 2026 Revised: May 11, 2026 Accepted: May 26, 2026 Published online: September 19, 2026 Processing time: 135 Days and 21.8 Hours
Abstract
BACKGROUND
Neuropsychiatric complications, such as post-stroke depression (PSD), post-stroke anxiety (PSA) and post-stroke cognitive impairment (PSCI), are common after stroke and have important impacts on functional recovery and quality of life. Although sleep disturbances and inflammation have been implicated, their combined role remains unclear.
AIM
To assess how post-stroke sleep disturbance and acute inflammation relate to and predict depression, anxiety, and cognitive impairment.
METHODS
This retrospective study included 160 stroke patients treated at The Second People’s Hospital of Nantong (2022-2025). Acute-phase inflammatory markers were collected during hospitalization, and sleep quality was evaluated at 1-3 months applying the Pittsburgh Sleep Quality Index (PSQI). Outcomes (PSD, PSA, PSCI) were evaluated utilizing the 17-item Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Montreal Cognitive Assessment. A principal component analysis was used to create a composite inflammatory indicator. Logistic regression and receiver operating characteristic curve analyses were conducted.
RESULTS
The incidences of PSD, PSA, and PSCI were 28.13%, 25.63%, and 40.63%, respectively. Sleep disturbance (PSQI > 5) significantly raised the risk for all outcomes [odds ratio (OR) range 2.22-2.34, all P < 0.05]. Both sleep disturbance and inflammatory burden were independent risk indicators (OR for inflammatory burden: 1.45-1.56, all P < 0.05). Area under the curves of the combined model (sleep + inflammation) for prediction of PSD, PSA, and PSCI were 0.664, 0.682, and 0.653, respectively, showing modestly better discriminative power compared with the single indicators.
CONCLUSION
Post-stroke sleep disturbance is independently associated with PSD, PSA, and PSCI as is acute inflammation. The sum of their assessment enhances risk stratification, helping in early intervention and personalized management.
Core Tip: This study systematically examined effects of sleep disturbance and inflammatory burden in the acute phase on post-stroke depression, anxiety and cognitive impairment. Sleep disturbance and inflammatory burden were both found to be independent risk factors for neuropsychiatric-cognitive adverse post-stroke outcomes. A combined assessment model further enhanced the discriminative performance and provided a scientific basis for early identification of high-risk patients and personalized intervention strategy.
