{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:59:34Z","timestamp":1785416374078,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007615","name":"Imam Abdulrahman Bin Faisal University","doi-asserted-by":"publisher","award":["2017-015-Med"],"award-info":[{"award-number":["2017-015-Med"]}],"id":[{"id":"10.13039\/501100007615","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2017-015-Med"],"award-info":[{"award-number":["2017-015-Med"]}],"id":[{"id":"https:\/\/ror.org\/038cy8j79","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Stroke remains a leading cause of death and long-term disability worldwide. Sleep disturbances are increasingly recognized as potential factors influencing recovery after stroke. Therefore, in this study we examined the associations of sleep disturbances and metabolic markers with post-stroke outcomes. Methods: We conducted a retrospective study of adult patients with stroke-related presentations. The primary analysis included 270 patients with follow-up mRS data. Extracted variables included demographics, vascular risk factors, stroke subtype, imaging findings, sleep features, and selected laboratory markers. Functional outcome was classified as favorable, mRS 0\u20132, or unfavorable, mRS 3\u20136. Recurrent stroke burden was analyzed as 0\u20131 versus \u22652 documented events. Associations and predictive performance were assessed using group comparisons, LASSO logistic regression, and random forest models with repeated 10-fold cross-validation. Results: Among 270 stroke patients, 214 (79.3%) had favorable outcomes and 56 (20.7%) had unfavorable outcomes. Sleep disturbances were common, especially nocturnal awakenings (59.6%), increased sleep apnea risk (44.4%), circadian rhythm disturbances (28.9%), and insomnia (23.7%). Unfavorable outcomes were linked to older age, cardio-aortic embolism, large vessel\/cortical stroke, abnormal vascular imaging, insomnia, and lower HDL. In LASSO analysis, age, steno-occlusive\/atherosclerotic imaging, cardio-aortic embolism, and insomnia predicted unfavorable outcome, while HDL was protective. For recurrent stroke, small artery occlusion and hypertension with diabetes were retained. In predictive modeling, the best random forest model showed good discrimination AUC values of 0.791 \u00b1 0.0126. Conclusions: Poorer stroke outcomes were associated with vascular factors, insomnia, and low HDL; recurrent events were mainly associated with small artery occlusion.<\/jats:p>","DOI":"10.3390\/jcm15145394","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:17:51Z","timestamp":1783606671000},"page":"5394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep Disturbances, Metabolic Markers, and Outcomes After Stroke: A Retrospective Cohort Study in a Tertiary Hospital"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0059-6679","authenticated-orcid":false,"given":"Fahad","family":"Alkhamis","sequence":"first","affiliation":[{"name":"Department of Neurology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6992-5341","authenticated-orcid":false,"given":"Majed M.","family":"Alabdali","sequence":"additional","affiliation":[{"name":"Department of Neurology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danah","family":"Aljaafari","sequence":"additional","affiliation":[{"name":"Department of Neurology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3453-6340","authenticated-orcid":false,"given":"Rudaynah A.","family":"Alali","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-8764","authenticated-orcid":false,"given":"Alawi H.","family":"Habara","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0528-413X","authenticated-orcid":false,"given":"Mohammed S.","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim S.","family":"Mohiuddin","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazim H.","family":"Habarah","sequence":"additional","affiliation":[{"name":"Department of Pathology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0536-536X","authenticated-orcid":false,"given":"Moyad M.","family":"Almuslim","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3026-5520","authenticated-orcid":false,"given":"Chittibabu","family":"Vatte","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3320-3723","authenticated-orcid":false,"given":"Brendan J.","family":"Keating","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery, New York University Langone Health, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery, New York University Langone Health, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0673-3534","authenticated-orcid":false,"given":"Amein K.","family":"Al-Ali","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","first-page":"101138","article-title":"The burden of cardiovascular disease in Asia from 2025 to 2050: A forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions","volume":"49","author":"Goh","year":"2024","journal-title":"Lancet Reg. Health West Pac."},{"key":"ref_2","unstructured":"(2021). GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol., 23, 973\u20131003."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1038\/s41582-023-00921-z","article-title":"Addressing disparities in the global epidemiology of stroke","volume":"20","author":"Prust","year":"2024","journal-title":"Nat. Rev. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S0140-6736(10)60834-3","article-title":"Risk Factors for Ischaemic and Intracerebral Haemorrhagic Stroke in 22 Countries: The INTERSTROKE Study: A Case-Control Study","volume":"376","author":"Xavier","year":"2010","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1161\/01.STR.0000106761.94985.8B","article-title":"Age and National Institutes of Health Stroke Scale Score within 6 Hours after Onset Are Accurate Predictors of Outcome after Cerebral Ischemia: Development and External Validation of Prognostic Models","volume":"35","author":"Weimar","year":"2004","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1212\/WNL.53.1.126","article-title":"Baseline NIH Stroke Scale Score Strongly Predicts Outcome after Stroke: A Report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)","volume":"53","author":"Adams","year":"1999","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101222","DOI":"10.1016\/j.smrv.2019.101222","article-title":"Incidence and Prevalence of Post-Stroke Insomnia: A Systematic Review and Meta-Analysis","volume":"49","author":"Baylan","year":"2020","journal-title":"Sleep Med. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"131","DOI":"10.5664\/jcsm.27760","article-title":"Frequency of Sleep Apnea in Stroke and TIA Patients: A Meta-Analysis","volume":"6","author":"Johnson","year":"2010","journal-title":"J. Clin. Sleep Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8409","DOI":"10.1038\/s41598-018-26630-y","article-title":"Post-Stroke Insomnia in Community-Dwelling Patients with Chronic Motor Stroke: Physiological Evidence and Implications for Stroke Care","volume":"8","author":"Sterr","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1164\/ajrccm.161.2.9903139","article-title":"Time Course of Sleep-Related Breathing Disorders in First-Ever Stroke or Transient Ischemic Attack","volume":"161","author":"Parra","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e1222","DOI":"10.1212\/WNL.0000000000005262","article-title":"CPAP as Treatment of Sleep Apnea after Stroke: A Meta-Analysis of Randomized Trials","volume":"90","author":"Brill","year":"2018","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1901104","DOI":"10.1183\/13993003.01104-2019","article-title":"EAN\/ERS\/ESO\/ESRS Statement on the Impact of Sleep Disorders on Risk and Outcome of Stroke","volume":"55","author":"Bassetti","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.smrv.2007.01.002","article-title":"The Metabolic Consequences of Sleep Deprivation","volume":"11","author":"Knutson","year":"2007","journal-title":"Sleep Med. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1080\/14737175.2018.1489239","article-title":"Sleep Disorders and the Risk of Stroke","volume":"18","author":"McDermott","year":"2018","journal-title":"Expert Rev. Neurother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.sleep.2023.02.019","article-title":"Post-stroke sleep disturbance and recurrent cardiovascular and cerebrovascular events: A systematic review and meta-analysis","volume":"104","author":"Hale","year":"2023","journal-title":"Sleep Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.nbscr.2016.11.003","article-title":"The role of sleep in recovery following ischemic stroke: A review of human and animal data","volume":"2","author":"Duss","year":"2017","journal-title":"Neurobiol. Sleep Circadian Rhythm."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/obr.12499","article-title":"Sleep-Obesity Relation: Underlying Mechanisms and Consequences for Treatment","volume":"18","year":"2017","journal-title":"Obes. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.4103\/2395-5414.157577","article-title":"Chi-Square Test and Its Application in Hypothesis Testing","volume":"1","author":"Rana","year":"2015","journal-title":"J. Pract. Cardiovasc. Sci."},{"key":"ref_19","unstructured":"Park, H.M. (2009). Comparing Group Means: T-Tests and One-Way ANOVA Using Stata, SAS, R, and SPSS, The University Information Technology Services Center for Statistical and Mathematical Computing, Indiana University."},{"key":"ref_20","first-page":"1","article-title":"mice: Multivariate Imputation by Chained Equations in R","volume":"45","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"168","DOI":"10.22237\/jmasm\/1430453640","article-title":"Applying Penalized Binary Logistic Regression with Correlation Based Elastic Net for Variables Selection","volume":"14","author":"Algamal","year":"2015","journal-title":"J. Mod. Appl. Stat. Methods"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"69","DOI":"10.58496\/BJML\/2024\/007","article-title":"Random Forest Algorithm Overview","volume":"2024","author":"Salman","year":"2024","journal-title":"Babylon. J. Mach. Learn."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s13312-011-0055-4","article-title":"Receiver Operating Characteristic (ROC) Curve for Medical Researchers","volume":"48","author":"Kumar","year":"2011","journal-title":"Indian Pediatr."},{"key":"ref_24","unstructured":"Han, H., Guo, X., and Yu, H. (2016, January 26\u201328). Variable Selection Using Mean Decrease Accuracy and Mean Decrease Gini Based on Random Forest. Proceedings of the 2016 7th IEEE International Conference on Software Engineering and Service Science (ICSESS), Beijing, China."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e078378","DOI":"10.1136\/bmj-2023-078378","article-title":"TRIPOD+AI statement: Updated guidance for reporting clinical prediction models that use regression or machine learning methods","volume":"385","author":"Collins","year":"2024","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e082505","DOI":"10.1136\/bmj-2024-082505","article-title":"PROBAST+AI: Risk of bias and applicability assessment tool for AI prediction model studies","volume":"388","author":"Moons","year":"2025","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1161\/hs0402.105909","article-title":"Predicting Outcome after Acute and Subacute Stroke: Development and Validation of New Prognostic Models","volume":"33","author":"Counsell","year":"2002","journal-title":"Stroke"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1177\/1545968320962501","article-title":"The Impact of Sleep Disorders on Functional Recovery and Participation Following Stroke: A Systematic Review and Meta-Analysis","volume":"34","author":"Fulk","year":"2020","journal-title":"Neurorehabilit. Neural Repair."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/sleep\/34.5.601","article-title":"The Insomnia Severity Index: Psychometric Indicators to Detect Insomnia Cases and Evaluate Treatment Response","volume":"34","author":"Morin","year":"2011","journal-title":"Sleep"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.apmr.2010.02.002","article-title":"Is Higher Serum Total Cholesterol Level Associated with Better Long-Term Functional Outcomes after Noncardioembolic Ischemic Stroke?","volume":"91","author":"Pan","year":"2010","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/01616412.2021.1967677","article-title":"The Prognostic Significance of the Lipid Profile after an Ischemic Stroke","volume":"44","author":"Vitturi","year":"2022","journal-title":"Neurol. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:31:47Z","timestamp":1783607507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":31,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145394"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145394","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}