Acting on feedback from forum members we have been contacting researchers that promoted research studies to ask what happened as a result. Our latest update is from the University of Glasgow.
On behalf of the researcher team, thank you very much for anyone in the forum that contributed towards our study.
We are very grateful for your support with our research, and towards improving understandings of insomnia after stroke.
We have now concluded the study and are happy to share the findings below.
Sensitivity and Specificity of the Sleep Condition Indicator When Screening for Insomnia Post-Stroke: A ROC Analysis
Declan M. McLaren [1], Jonathan Evans [2], Satu Baylan [2,3], Monika Harvey [1],
Megan Montgomery [1], Maria Gardani [4]
[1] University of Glasgow, School of Psychology & Neuroscience
[2] University of Glasgow, Institute of Health & Wellbeing
[3] Regional Neuropsychology Services, NHS Greater Glasgow and Clyde
[4] University of Edinburgh, School of Health in Social Science
Background:
Insomnia is common after stroke, more so than in the general population. Recent research suggests that between roughly 33% and 50% of stroke survivors will experience symptoms of insomnia after their stroke (1,2). Despite this, researchers have only recently begun exploring the best ways to detect insomnia after stroke. To date, no study has explored the best method to detect insomnia after stroke in English-speakers.
The Sleep Condition Indicator (SCI; 3) is a short questionnaire designed to detect symptoms of insomnia disorder. Total scores on the SCI can range from 0-32, with lower scores suggesting poorer sleep. In the general population, a score of 16 or less is generally thought to indicate the presence of insomnia disorder (3,4).
This study aimed to assess how accurately the SCI could discriminate between stroke survivors with and without insomnia, and at what cut-off score it performed best.
What we did:
We recruited 180 people who had experienced one or more strokes via social media adverts, and with support of the Stroke Association and other third sector organisations. Participants completed an online questionnaire that asked them questions about their stroke, their mental health, themselves, and their sleep. Researchers examined the data provided by participants and placed them into three categories: âinsomnia disorderâ, âinsomnia symptomsâ, and âno insomniaâ. We were then able to compare the scores on the SCI and see how accurately it could detect which participants had insomnia, and which didnât. We could also determine which cut-off score brought about the greatest overall accuracy.
What we found:
Our study was the first to examine the accuracy of an insomnia screening tool is a sample of English-speaking stroke survivors. Overall, the SCI demonstrated âexcellentâ diagnostic accuracy; showing that it is a valid tool for detecting insomnia after stroke. We did find, however, that the SCI was most accurate when we used a cut-off score of 13 or less; lower than the traditional cut-off score of 16 or less. If the traditional cut-off score were used, the SCI would have incorrectly classified roughly half of people who did not have insomnia, as having insomnia. Therefore, clinicians and researchers interested in using the SCI to detect insomnia after stroke should consider using the lower threshold of less than or equal to 13 to indicate insomnia disorder.
Next steps:
Our hope is that this research will improve how accurately and efficiently insomnia is detected in practice, leading to timely diagnosis and treatment, allowing people to return to having a better relationship with their sleep.
We now intend to use the SCI to assess how effectively a new treatment can improve the symptoms of insomnia in people who have had a stroke.
Further information:
If youâd like to read about our study in more detail, you can access the pre-print at: OSF
References
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Baylan S, Griffiths S, Grant N, Broomfield NM, Evans JJ, Gardani M. Incidence and prevalence of post-stroke insomnia: A systematic review and meta-analysis. Sleep Med Rev. 2020 Feb;49:101222.
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Hasan F, Gordon C, Wu D, Huang HC, Yuliana LT, Susatia B, et al. Dynamic Prevalence of Sleep Disorders Following Stroke or Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke. 2021 Feb;52(2):655â63.
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Espie CA, Kyle SD, Hames P, Gardani M, Fleming L, Cape J. The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder. BMJ Open. 2014 Mar 18;4(3):e004183.
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Espie CA, Farias Machado P, Carl JR, Kyle SD, Cape J, Siriwardena AN, et al. The Sleep Condition Indicator: reference values derived from a sample of 200 000 adults. J Sleep Res. 2018 Jun;27(3):e12643.
