Liu XA, Liu J, Xu D, Zhao X. Inflammation, sleep-circadian disruption, and neuropsychiatric recovery after stroke: Mechanisms and integrated interventions for post-stroke depression and anxiety. World J Psychiatry 2026; 16(11): 125243 [DOI: 10.5498/wjp.125243]
Corresponding Author of This Article
Xia Zhao, Director, Department Five of Neurology Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 33 Beiling Street, Shenyang 110000, Liaoning Province, China. zhaoxia57157@126.com
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Medicine, Research & Experimental
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review-article
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Liu XA, Liu J, Xu D, Zhao X. Inflammation, sleep-circadian disruption, and neuropsychiatric recovery after stroke: Mechanisms and integrated interventions for post-stroke depression and anxiety. World J Psychiatry 2026; 16(11): 125243 [DOI: 10.5498/wjp.125243]
World J Psychiatry. Nov 19, 2026; 16(11): 125243 Published online Nov 19, 2026. doi: 10.5498/wjp.125243
Inflammation, sleep-circadian disruption, and neuropsychiatric recovery after stroke: Mechanisms and integrated interventions for post-stroke depression and anxiety
Xing-An Liu, Jun Liu, Dan Xu, Xia Zhao
Xing-An Liu, Jun Liu, Department III of Neurology Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110000, Liaoning Province, China
Dan Xu, Department of Psychiatry, Shenyang Mental Health Center, Shenyang 110062, Liaoning Province, China
Xia Zhao, Department Five of Neurology Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110000, Liaoning Province, China
Author contributions: Liu XA contributed to the conception and design of the study, data curation, methodology, software development, and drafted the original manuscript; Liu J and Xu D carried out formal analysis, project administration and visualization; Zhao X conducted investigation, supervision and validation, and revised the manuscript; and all authors read and approved the final submitted manuscript.
AI contribution statement: Only the content in the “Answering-Reviewers” file is suitable for being polished by AI.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Xia Zhao, Director, Department Five of Neurology Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 33 Beiling Street, Shenyang 110000, Liaoning Province, China. zhaoxia57157@126.com
Received: July 3, 2026 Revised: July 22, 2026 Accepted: August 10, 2026 Published online: November 19, 2026 Processing time: 118 Days and 0.2 Hours
Abstract
Depression and anxiety after stroke are common neuropsychiatric disorders that disrupt participation in rehabilitation programs, quality of life, and functional outcomes. These symptoms rarely occur in isolation, and are often accompanied by sleep disturbances, fatigue, reduced daytime activity, and circadian dysregulation. Sleep disorders after stroke, including insomnia, poor sleep quality, disordered breathing, and excessive sleepiness during the daytime. These symptoms may result from emotional disturbances and exacerbate poor recovery. Although circadian disruption is less commonly evaluated, it may also influence mood through alterations in sleep-wake timing, light exposure, activity rhythms, neuroendocrine function, and immune function. Inflammation may represent a biologically plausible pathway linking stroke injury, sleep-circadian disruption, and mood symptomatology by influencing neurotransmitter metabolism, hypothalamic-pituitary-adrenal axis activity, and frontolimbic emotional networks. Conversely, sleep disruption and circadian misalignment may amplify inflammatory signaling, fatigue, and reduced participation in rehabilitation, thereby contributing to persistent depressive and anxiety symptoms. This article synthesizes current evidence on the clinical associations and shared inflammatory network mechanisms linking post-stroke depression and anxiety with sleep disturbances and circadian dysregulation. It also proposes an integrated framework combining mood and sleep-circadian assessment, contextual interpretation of inflammatory biomarkers, and phenotype-based management.
Core Tip: This article synthesizes evidence on the clinical interplay between post-stroke depression/anxiety, sleep disturbance, and circadian dysregulation, highlighting shared inflammatory mechanisms. It proposes a comprehensive framework integrating mood monitoring, sleep-circadian evaluation, biomarker assessment, and phenotype-based interventions to address these interconnected contributors to poor functional recovery and rehabilitation outcomes.
