中国卒中杂志2019，Vol.14Issue(4)：317-326,10.DOI:10.3969/j.issn.1673-5765.2019.04.004
睡眠时相相关阻塞性睡眠呼吸暂停对急性脑梗死患者睡眠结构及预后的影响
Effect of Sleep Phase Related Obstructive Sleep Apnea on Sleep Structure and Prognosis of Acute Ischemic Stroke Patients
摘要
Abstract
Objective To investigate the effect of REM and non-rapid eye movement (NREM) sleep related OSA on sleep structure and prognosis of acute ischemic stroke (AIS) patients. Methods Data of consecutive AIS patients with PSG examination in the Second Affiliated Hospital of Soochow University from Feburary 2011 to August 2018 were resepectively colleted.Collected data included the general information, emotion and cognition assessment, sleep scales, MRI and PSG findings, the NIHSS scores at 48 hours after admission and at discharge, and mRS scores at discharge and 3 months. According to overall AHI, AHI during REM (REM-AHI) and during NREM (NREM-AHI), they were divided into AIS group, AIS+REM-related OSA group and AIS+NREM-related OSA group. Univariate and multivariate analyses were used to analyze the effect of sleep phase related OSA on sleep architecture and prognosis of AIS patients. Results A total of 110 eligible patients were enrolled in this study, with 30 (27.3%) in AIS group, 15 (13.6%) in AHI+REM-related OSA group and 65 (59.1%) in AHI+NREM-related OSA group. BMI was more higher in AIS+NREM-related OSA group than that in AIS group. The lesions of AIS group were mostly located in telencephalon, while the lesions of AIS+REM-related OSA group were located in brain stem, telencephalon and diencephalon. The time and proportion of NREM 1 were higher and the time and proportion of slow wave sleep (SWS) were shorter in AIS+NREM-related OSA group than that in AIS group.Microarousal index, respiratory related microarousal index, spontaneous microarousal index were higher in AIS+NREM-related OSA group than that in AIS+REM-related OSA group. There was no difference in mRS score at 3 months.Logistic analysis results revealed that high NIHSS score on admission, the low level of education and high BMI were independent risk factors of poor prognosis of AIS patients. Conclusions Sleep structure of AIS can be disturbed by NREM-related OSA, with sleep characteristics of longer NREM1, shorter deep sleep (NREM 3 and 4) and fragmentation. These changes may result in worse prognosis of AIS.关键词
脑梗死/睡眠呼吸暂停/快动眼睡眠/非快动眼睡眠/预后Key words
Ischemic stroke/Obstructive sleep apnea/Rapid eye movement sleep/Non rapid eye movement sleep/Prognosis引用本文复制引用
CHEN Qin,LI Jie,MAO ChengJie,SHEN Yun,FU Xiang,LIU YuLu,LIU ChunFeng..睡眠时相相关阻塞性睡眠呼吸暂停对急性脑梗死患者睡眠结构及预后的影响[J].中国卒中杂志,2019,14(4):317-326,10.基金项目
苏州市科技发展计划——产业技术创新专项(民生科技——医疗卫生应用基础研究)项目(SYSD2016096)苏州市临床医学中心项目(Szzx201503)江苏省医学重点学科(ZDxKB2016022)苏州市科技计划项目(SYS201624) （民生科技——医疗卫生应用基础研究）
