Sleep Disorders in Moyamoya Disease: Prevalence, Risk Factors, and Impact on Functional Outcomes.

INTRODUCTION Sleep disorders are prevalent but frequently overlooked in Moyamoya Disease (MMD), with their clinical impact remaining inadequately characterized. This study aimed to determine the prevalence of sleep disorders, assess their effect on functional outcomes, and identify independent predictors in MMD patients.

METHODS This prospective cohort study enrolled 320 consecutive adult MMD patients. Sleep quality, anxiety, depression, and insomnia symptoms were evaluated using the PSQI, SAS, SDS, and AIS, respectively. Two independent reviewers assessed clinical and radiological outcomes. Multivariate logistic regression was employed to identify independent risk factors for sleep disorders.

RESULTS Of the 320 patients (184 females, mean age 45±11 years), 52.1% with sleep disorders had poor functional outcomes (mRS≥2) at admission, which persisted in 55.1% at 3 months post- EDAS. Multivariate analysis revealed that female gender (OR: 5.37, 95% CI: 2.30-12.56), older age (OR: 1.05, 95% CI: 1.01-1.09), headache (OR: 9.25, 95% CI: 1.96-43.67), alcohol consumption (OR: 3.94, 95% CI: 1.68-9.22), anxiety (OR: 4.18, 95% CI: 1.44-12.16), depression (OR: 21.22, 95% CI: 2.53-177.90), higher admission and postoperative mRS scores, and impaired hemodynamic parameters (TTP, rCBV, rCBF) were independent risk factors. Sleeping pill use was a protective factor (OR: 0.16, 95% CI: 0.06-0.42).

DISCUSSION AND CONCLUSION Sleep disorders are common and adversely impact functional recovery in MMD, yet remain underrecognized. The identified multivariable risk profile underscores the necessity of integrating routine sleep screening and comprehensive management into standard MMD care to improve patient prognosis.