脑卒中后睡眠障碍的发病机制及康复治疗OA北大核心CSTPCD
Pathogenesis and Rehabilitation Therapy of Sleep Disorder after Stroke
脑卒中后睡眠障碍分为睡眠呼吸障碍(SDB)、失眠、日间嗜睡(EDS)与不宁腿综合征(RLS),对脑卒中患者认知、运动等功能预后及生活质量影响较大,应尽早针对脑卒中患者的睡眠障碍开展康复治疗.本研究对脑卒中后睡眠障碍的发病机制与康复治疗研究现状进行综述,其中脑卒中后睡眠障碍发病机制研究主要包括脑卒中后SDB[阻塞性睡眠呼吸暂停综合征(OSAS)、中枢性睡眠呼吸暂停综合征(CSAS)与混合型睡眠呼吸暂停综合征(MSAS)]发病机制;脑卒中后失眠发病机制;脑卒中后EDS发病机制;脑卒中后RLS发病机制.脑卒中后睡眠障碍康复治疗主要包括脑卒中后SDB康复治疗[持续气道正压通气(CPAP)、体位治疗、口咽肌训练];脑卒中后失眠康复治疗[认知行为疗法(CBT)、针刺疗法、无创性经颅神经调控技术(低频重复经颅磁刺激和经颅直流电刺激)和光照疗法];脑卒中后EDS康复治疗(CPAP和光照疗法);脑卒中后RLS康复治疗(针刺).但脑卒中后睡眠障碍的发病机制尚未完全明确,其基础研究仍处于表型确定阶段;康复治疗仍存在治疗依从性、安全性、精准度等方面的问题,且脑卒中后EDS和RLS的康复研究较少.下一步研究需要探索适合脑卒中后睡眠障碍研究的实验动物模型,为开展基础性研究提供支撑;同时,开展更多高质量、大样本、多中心的临床随机对照试验,为脑卒中后睡眠障碍的康复治疗提供参考.
Sleep disorder after stroke are classified into sleep-disordered breathing(SDB),insomnia,excessive daytime sleepi-ness(EDS)and restless legs syndrome(RLS),which have a great impact on the prognosis of cognitive and motor functions and the quality of life of stroke patients.Rehabilitation treatment for sleep disorder in stroke patients should be initiated as early as possible.This study provides an overview of the pathogenesis and rehabilitation treatment of sleep disorder after stroke.The pathogenesis research of post-stroke sleep disorder mainly includes the pathogenesis of SDB[obstructive sleep apnea syndrome(OSAS),central sleep apnea syndrome(CSAS)and mixed sleep apnea syndrome(MSAS)],insomnia,EDS and RLS.Research on rehabilitation treat-ments for post-stroke sleep disorder mainly includes rehabilitation treatments for SDB[continuous positive airway pressure(CPAP),body positioning therapy,and oropharyngeal muscle training],insomnia[cognitive behavioral therapy(CBT),acupuncture,non-inva-sive transcranial neuromodulation techniques(low-frequency repetitive transcranial magnetic stimulation and transcranial direct cur-rent stimulation),and light therapy],EDS(CPAP and light therapy)and RLS(acupuncture).However,the pathogenesis of post-stroke sleep disorder is not yet fully clarified,and its basic research is still at the phenotypic determination stage.Issues such as treat-ment compliance,safety,and accuracy remain in rehabilitation treatment,and there is limited research on the rehabilitation of post-stroke EDS and RLS.Future explorations are needed on experimental animal models suitable for the basic research on post-stroke sleep disorder.In addition,more high-quality,large-sample,multicenter clinical randomized controlled trials are needed to pro-vide references for the rehabilitation treatment of post-stroke sleep disorder.
韩旭;谢鸿宇;汤昕未;吴毅
复旦大学附属华山医院,上海 200040
脑卒中睡眠障碍发病机制康复治疗
strokesleep disorderpathogenesisrehabilitation
《康复学报》 2024 (002)
186-194 / 9
科技部"主动健康和老龄化科技应对"重点研发专项(2018YFC2001700);上海市科学技术委员会长三角联合攻关项目(20412420200)
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