Background Exercise (EX) or cognitive and social enrichment (ENRICH) are two strategies for promoting cognition post-stroke. Whether sleep moderates the effects of EX or ENRICH on cognition in adults with chronic stroke is unknown. Methods A three-arm parallel randomized clinical trial among community-dwelling adults aged 55+ years with chronic stroke (i.e., ≥12 months since stroke). Participants were randomized to 2x/week EX, ENRICH, or balance and tone control (BAT). At baseline, device-measured sleep duration and efficiency were measured using wrist-worn actigraphy; self-reported quality was measured by Pittsburgh Sleep Quality Index (PSQI). Participants were categorized at baseline as having good or poor device-measured duration, device-measured efficiency, or self-reported quality based on PSQI. The primary cognitive outcome was Alzheimer’s Disease Assessment Scale Plus (ADAS-Cog-Plus) measured at baseline, 6 months (end of intervention), and 12 months (6-month follow-up). We examined if baseline sleep categorizations (i.e., good/poor) moderated effects of EX or ENRICH on ADAS-Cog-Plus. Results We enrolled 120 participants in the trial (EX=34; ENRICH=34; BAT=52). Sleep quality (i.e., device-measured sleep efficiency or self-reported sleep quality) categorization moderated effects of EX (but not ENRICH) on ADAS-Cog-Plus. Compared with BAT participants with poor sleep quality, EX participants with poor sleep quality had better ADAS-Cog-Plus performance at 6 months (estimated mean difference for those with poor device-measured sleep efficiency: -0.48; 95% CI:[-0.85, -0.10]; p=0.010); estimated mean difference for those with poor self-reported sleep quality: -0.38; 95% CI:[-0.70, -0.07]; p=0.014). There was no effect of EX on ADAS-Cog-Plus for participants with good sleep quality. Device-measured sleep duration did not moderate intervention effects. Conclusion Exercise is particularly beneficial in improving cognitive function in adults with chronic stroke and poor sleep quality.

中文翻译：

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睡眠是否能缓和运动训练或复杂的心理和社会活动对成人慢性卒中患者认知功能的影响？随机试验的二次分析


背景锻炼 （EX） 或认知和社交丰富 （ENRICH） 是促进中风后认知的两种策略。睡眠是否能调节 EX 或 ENRICH 对成人慢性卒中认知的影响尚不清楚。方法 一项针对 55+ 岁患有慢性中风 （即中风 ≥12 个月） 的社区居民的三臂平行随机临床试验。参与者被随机分配到每周 2 次 EX、ENRICH 或平衡和语气控制 （BAT） 组。在基线时，使用腕戴式活动记录仪测量设备测量的睡眠持续时间和效率;自我报告的质量通过匹兹堡睡眠质量指数 （PSQI） 来衡量。参与者在基线时被分类为设备测量的持续时间、设备测量的效率或基于 PSQI 的自我报告质量的好或差。主要认知结局是在基线、6 个月 （干预结束） 和 12 个月 （6 个月随访） 时测量的阿尔茨海默病评估量表 Plus （ADAS-Cog-Plus）。我们检查了基线睡眠分类 （即好/差） 是否调节了 EX 或 ENRICH 对 ADAS-Cog-Plus 的影响。结果 我们招募了 120 名参与者参加试验 （EX=34;丰富=34;BAT=52）。睡眠质量（即设备测量的睡眠效率或自我报告的睡眠质量）分类调节了 EX（但不是 ENRICH）对 ADAS-Cog-Plus 的影响。与睡眠质量差的 BAT 参与者相比，睡眠质量差的 EX 参与者在 6 个月时具有更好的 ADAS-Cog-Plus 性能（设备测量睡眠效率差者的估计平均差异：-0.48;95% CI：[-0.85，-0.10];p=0.010）;自我报告睡眠质量差的人的估计平均差：-0.38;95% CI：[-0.70， -0.07];p = 0.014）。 对于睡眠质量良好的参与者，EX 对 ADAS-Cog-Plus 没有影响。设备测量的睡眠持续时间并未减轻干预效果。结论 运动对改善慢性脑卒中和睡眠质量差成人的认知功能特别有益。