Objective:

To determine whether sleep quality and cognitive function after AIS show asynchronous rather than automatically parallel recovery trajectories during the first year after discharge, and to identify distinct joint trajectory subgroups and baseline factors associated with trajectory membership.

Approach:

• Study Design: Single-center prospective cohort study conducted in Shanghai from December 2023 to October 2024, involving 515 participants.

Key Findings:

• Three distinct trajectory classes identified: C1 (sleep improvement–cognitive decline, 29.51%, n = 152), C2 (sleep decline–cognitive improvement, 43.30%, n = 223), C3 (sleep improvement–cognitive improvement, 27.18%, n = 140).
• Predictors for C2 membership included widowhood, left-hemisphere infarction, and prior stroke history.
• For C3, unmarried status was associated with higher odds of membership, while left-hemisphere infarction and baseline PSQI were associated with lower odds.
• No significant between-class differences in NIHSS, Barthel Index, or IADL at follow-up; PHQ-9 scores increased over time.

Interpretation:

The study indicates that AIS survivors exhibit heterogeneous and sometimes asynchronous joint sleep-cognition trajectories, which may inform targeted follow-up and individualized management.

Limitations:

• Single-center study may limit generalizability.
• Short follow-up period may not capture long-term trajectories.

Conclusion:

Joint trajectory stratification and its correlates may inform follow-up and management.