Factors Influencing Sleep and Post-Discharge Care-Seeking Attitudes in Hospitalized Stroke Patients: A Regional Study in Wales, UK

Background: Sleep disruption is a prevalent yet under-recognised issue among stroke patients, with growing evidence suggesting its adverse impact on neurological recovery and rehabilitation. This study explores the causes of in-hospital sleep disturbances and evaluates post-discharge care-seeking behaviours in a stroke patient cohort.

Methods: A retrospective cohort study was conducted at Wrexham Maelor Hospital, North Wales, using data from the Sentinel Stroke National Audit Programme (SSNAP), the Welsh Clinical Portal, and EPOC from March 2024 to March 2025. A structured questionnaire was administered post-discharge to assess self-reported sleep quality across three time periods: pre-stroke, during hospitalisation, and after discharge. Contributing factors to sleep disturbance and patient interactions with healthcare providers regarding sleep concerns were also examined.

Results: Among 225 stroke patients, environmental factors were the most frequently reported causes of in-hospital sleep disruption, with noise (n=139) being the leading factor, followed by clinical interventions (n=82), lighting (n=36), anxiety/stress (n=23), pain (n=22), and disability (n=19). Despite widespread disturbances, only 13.3% of patients reported discussing sleep issues with their general practitioner post-discharge, and fewer than 10% received any formal management for sleep-related concerns.

Conclusion:

This study demonstrates that sleep disturbances are highly prevalent among hospitalised stroke patients with environmental factors, emerging as key disruptors. Sleep is a vital aspect of neurological recovery. The inconsistent acknowledgement and therefore inconsistent management of sleep disturbance reinforce the need for routine assessment, staff education on the importance of sleep, and environmental modifications to enhance rest and facilitate timely rehabilitation. In summary, sleep should be regarded not as an ancillary aspect of care but as a core component of stroke management. Embedding this perspective within stroke pathways offers a tangible means of improving recovery rates, reducing disability, and enhancing quality of life for stroke survivors.