İlknur Aykurt Karlıbel, Mertcan Ay, Hüseyin Engin, İsmail Hakkı Aydoğdu, Hande Özgen
In chronic ischemic stroke, greater hemiplegic DTF is independently associated with better function, mobility, and quality of life, and fewer sleep and mood problems. A DTF around 21% may serve as a practical threshold for risk stratification and rehabilitation targeting.
OBJECTIVES: To examine whether hemiplegic diaphragm thickening fraction (DTF, %) is associated with functional status, walking capacity, sleep quality, mood, and stroke-specific quality of life (SS-QoL) in chronic ischemic stroke, and to determine a clinically useful DTF threshold.
MATERIALS AND METHODS: This single-center cross-sectional study included 68 patients with chronic ischemic stroke (≥6 months). Hemiplegic DTF was quantified by ultrasonography. Outcome measures were the Barthel index (BI), Functional Ambulation Category, 6-minute walk test (6-MWT), SS-QoL, Pittsburgh sleep quality index (PSQI), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Hospital Anxiety and Depression Scale-Depression (HADS-D) scales, and Fugl-Meyer upper extremity (FMA-UE). Statistical analyses included non-parametric comparisons (DTF ≤20% vs. >20%), Spearman correlations, and multivariable regression adjusted for age, sex, body mass index, and stroke duration. Receiver operating characteristic and logistic regression analyses examined PSQI >5.
RESULTS: Hemiplegic diaphragm dysfunction (DTF ≤20%) was present in 36.8% of participants. Higher DTF was independently associated with better BI, 6-MWT, and SS-QoL scores, and with lower PSQI, HADS-A, and HADS-D scores (all p<0.05), but not with FMA-UE. DTF showed good discrimination for poor sleep [area under the curve: 0.779, 95% confidence interval (CI): 0.649-0.892], with an optimal threshold around 21% (sensitivity 0.77, specificity 0.83). Each 1% increase in DTF reduced the odds of poor sleep by approximately 7% (odds ratio ≈ 0.93; 95% CI: 0.89-0.98).
CONCLUSION: In chronic ischemic stroke, greater hemiplegic DTF is independently associated with better function, mobility, and quality of life, and fewer sleep and mood problems. A DTF around 21% may serve as a practical threshold for risk stratification and rehabilitation targeting.