Abstract:
Background: Post-stroke spasticity is a common neurological complication that can impair mobility,
functional independence, and overall quality of life. While its impact on daily activities is well-
documented, the relationship between spasticity severity and sleep quality remains underexplored.
Poor sleep may further hinder neurological recovery and rehabilitation outcomes.Objective: To
investigate the correlation between spasticity severity and sleep quality in post-stroke patients and
evaluate the differential impact of upper- versus lower-limb spasticity.Methods: A cross-sectional
observational study was conducted on 60 post-stroke patients aged 30–75 years, attending
neurorehabilitation outpatient clinics. Spasticity was assessed using the Modified Ashworth Scale
(MAS) for upper and lower limbs, while sleep quality was measured using the Pittsburgh Sleep
Quality Index (PSQI). Secondary outcomes included pain (Visual Analog Scale) and functional
independence (FIM). Correlations between MAS and PSQI scores were analyzed using Spearman’s
correlation, and subgroup analyses compared upper- versus lower-limb spasticity.Results: The mean
age of participants was 58 ± 10 years; 60% were male. Spasticity severity was higher in lower limbs
(MAS 2.1 ± 0.8) than upper limbs (MAS 1.8 ± 0.7). Poor sleep quality (PSQI >5) was reported by
70% of patients. Significant moderate positive correlations were observed between MAS and PSQI
scores (upper limb: ρ = 0.42, p = 0.002; lower limb: ρ = 0.48, p = 0.001), indicating that higher
spasticity was associated with poorer sleep. Lower-limb spasticity had a slightly stronger impact on
sleep quality.Conclusion: Post-stroke patients with more severe spasticity, particularly in the lower
limbs, are prone to poorer sleep quality.
