中国中西医结合急救杂志2025，Vol.32Issue(5)：532-538,7.DOI:10.3969/j.issn.1008-9691.2025.05.004
急性缺血性脑卒中患者睡眠障碍风险预测评分系统的构建
Establishment of a sleep-disorder risk-prediction scoring system for patients with acute ischemic stroke
摘要
Abstract
Objective To construct a sleep-disorder risk-prediction scoring system for patients with acute ischemic stroke(AIS),and evaluate its predictive efficacy.Methods A prospective observational study was conducted.A total of 531 AIS patients admitted to the Second Affiliated Hospital of Anhui Medical University from January 2022 to December 2024 were enrolled as the modeling group,and 225 AIS patients admitted to the First Affiliated Hospital of Anhui Medical University during the same period were enrolled as the validation group.Data including gender,age,body mass index(BMI),chronic disease status(cardiovascular disease,diabetes,hypertension),smoking history,drinking history,stroke location,laboratory test indicators[including hemoglobin(Hb),albumin(Alb),lymphocyte count(LYM),triglycerides(TG),total cholesterol(TC),C-reactive protein(CRP)],National Institutes of Health Stroke Scale(NIHSS)score,and patient health questionnaire-9(PHQ-9)scale depression screening score at 3 months after discharge were collected.The patients in the modeling group were divided into those with sleep disorder risk and those without sleep disorder risk based on the Pittsburgh sleep quality index(PSQI).Univariate and multivariate Logistic regression analyses were used to screen risk factors.A sleep disorder risk prediction scoring model for AIS patients was constructed based on the variable types and regression coefficient β values of risk factors.The accuracy of the model was evaluated using calibration curves and Hosmer-Lemeshow goodness-of-fit test.The receiver operator characteristic curve(ROC curve)was drawn to assess the discrimination ability of the model and determine the risk threshold.Results There were no statistically significant differences in baseline data between the modeling group and the validation group,indicating that the two groups were balanced and comparable.There were 106 patients with sleep disorder risk and 425 patients without sleep disorder risk in the modeling group.Multivariate analysis showed that age increase,stroke location being subcortical,NIHSS score<5,elevated Alb,and increased PHQ-9 score were independent predictors of sleep disorder risk.A risk nomogram model was constructed.The Hosmer-Lemeshow goodness-of-fit test of internal validation showed that the model had good calibration performance(χ2=8.578,P=0.379),and the actual incidence of sleep disorder in each risk layer was close to the predicted value of the model.The area under the curve(AUC)was 0.863,95%confidence interval(95%CI)was 0.796-0.930,indicating good discrimination ability of the model;when the prediction score threshold was 0.166,the Youden index was the maximum at 0.620,with a sensitivity of 79.6%and a specificity of 82.4%.Decision curve analysis(DCA)showed that the clinical net benefit of the model was significantly higher than that of"treat-all"or"treat-none"strategies across a wide range of thresholds.The AUC of the validation group was 0.837,95%CI was 0.791-0.882.Hosmer-Lemeshow goodness-of-fit test showed that the model's predicted risk was consistent with the actual risk(χ2=4.901,P=0.768),and the calibration curve further verified its accuracy.When the threshold was set at 0.242,the sensitivity was 76.3%,the specificity was 79.9%,and the Youden index was 0.560.DCA showed that when the threshold probability was 15%-75%,using this model for intervention guidance could consistently achieve clinical net benefits,especially in the 30%-60%threshold range with the largest increase in benefit.Conclusion The risk-assessment system constructed in this study has good predictive performance and can be used as an important tool for sleep-disorder risk assessment in patients with AIS.关键词
急性缺血性脑卒中/风险评估/睡眠障碍/评分系统/预测模型Key words
Acute ischemic stroke/Risk assessment/Sleep disorder/Scoring system/Predictive model引用本文复制引用
曹磊,相苗苗,刘学春,谢晓慧,江伟,蔡卓磊,谢成娟,王芳,郑云..急性缺血性脑卒中患者睡眠障碍风险预测评分系统的构建[J].中国中西医结合急救杂志,2025,32(5):532-538,7.基金项目
国家自然科学基金(82503087) National Natural Science Foundation of China(82503087) （82503087）
