Correlation Between Spasticity Severity and Sleep Quality in Post-Stroke Patients: An Observational Study

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.