Multidimensional sleep health is associated with affective instability in community‐dwelling survivors of stroke : an ecological momentary assessment study

Abstract

Background: Affective instability is a form of emotion dysregulation and a known precursor to affective disorders. Sleep plays a critical role in emotional regulation. Survivors of stroke frequently experience disrupted sleep that contributes to affective disturbances, but the specific dimensions of sleep health associated with affective instability remain unclear. Objective: To examine the associations between dimensions of sleep health and affective instability in survivors of stroke. Methods: A secondary analysis of a 7-day prospective study involving 40 community-dwelling survivors of stroke who completed daily sleep diaries and eight daily ecological momentary assessments (EMA). Affective instability was assessed with EMA and quantified using mean squared successive difference (MSSD) and probability of acute change (PAC). Six dimensions of sleep health were assessed via EMA, sleep diaries, and the Pittsburgh Sleep Quality Index. Multivariable linear regression analyses were conducted to examine associations of sleep health with affective instability. Results: Higher mental fatigue (MSSD: β =.55, p =.001; PAC: β =.76, p <.001), lower sleep efficiency (PAC: β = −.35, p =.036), and longer sleep latency (PAC: β =.38, p =.030) were associated with greater depressed affect instability. More irregular mid-sleep timing (MSSD: β =.57, p <.001; PAC: β =.48, p =.004), more irregular sleep duration (MSSD: β =.43, p =.012), later sleep timing (MSSD: β =.51, p =.002), and longer sleep latency (MSSD: β =.39, p =.020; PAC: β =.39, p =.021) were associated with greater cheerful affect instability. Conclusions: Poorer sleep efficiency, higher mental fatigue, later sleep timing, and more irregular sleep patterns were associated with greater affective instability. Designing behavioral therapies targeting these sleep health dimensions may reduce affective instability and prevent post-stroke affective disorders.