Koch Sebastian, Zuniga Sylvia, Rabinstein Alejandro A, Romano Jose G, Nolan Bruce, Chirinos Julio, Forteza Alejandro
Department of Neurology, University of Miami, School of Medicine, FL, USA.
J Stroke Cerebrovasc Dis. 2007 May-Jun;16(3):114-8. doi: 10.1016/j.jstrokecerebrovasdis.2007.01.002.
In animal models, brief periods of hypoxemia render the brain tolerant to subsequent ischemic insults. Sleep apnea leads to frequent episodes of nocturnal hypoxemia and may induce ischemic tolerance. Snoring and daytime sleepiness are cardinal symptoms of sleep apnea. We undertook this study to determine differences in stroke severity and early neurologic course in patients at risk for sleep apnea as determined by a sleep questionnaire.
Patients admitted with acute ischemic stroke completed the Berlin questionnaire. The Berlin questionnaire examines habitual snoring, daytime sleepiness, presence of hypertension, and body mass index (BMI) and classifies patients into a high or low risk for sleep apnea group. National Institutes of Health Stroke Scale (NIHSS) score was determined on admission and day 5 of hospitalization. Age, sex, cardiovascular risk factors, BMI, and stroke mechanism were determined prospectively.
We enrolled 190 patients with a mean age of 60 years and 53% were men. The Berlin questionnaire classified 103 patients (54%) at high risk for sleep apnea. The median NIHSS score on admission and day 5 of hospitalization did not differ between the two groups after multivariate analysis. Examined separately, we found no effect of snoring, daytime sleepiness, or BMI on acute stroke severity and outcome.
We found that a large number of patients admitted with acute ischemic stroke were at high risk for having sleep apnea. We were not able to show that a constellation of symptoms and features highly suggestive of sleep apnea influenced stroke severity or early neurologic course after acute ischemic stroke.
在动物模型中，短暂的低氧血症可使大脑对随后的缺血性损伤产生耐受性。睡眠呼吸暂停会导致夜间频繁出现低氧血症，并可能诱导缺血耐受性。打鼾和日间嗜睡是睡眠呼吸暂停的主要症状。我们进行这项研究，以确定通过睡眠问卷确定的睡眠呼吸暂停风险患者在中风严重程度和早期神经病程方面的差异。
急性缺血性中风患者入院时完成柏林问卷。柏林问卷检查习惯性打鼾、日间嗜睡、高血压的存在情况以及体重指数（BMI），并将患者分为睡眠呼吸暂停高风险或低风险组。在入院时和住院第5天测定美国国立卫生研究院卒中量表（NIHSS）评分。前瞻性地确定年龄、性别、心血管危险因素、BMI和中风机制。
我们纳入了190例患者，平均年龄60岁，53%为男性。柏林问卷将103例患者（54%）分类为睡眠呼吸暂停高风险。多变量分析后，两组在入院时和住院第5天的NIHSS评分中位数无差异。单独检查发现，打鼾、日间嗜睡或BMI对急性中风严重程度和预后无影响。
我们发现，大量急性缺血性中风患者存在睡眠呼吸暂停高风险。我们未能表明一系列高度提示睡眠呼吸暂停的症状和特征会影响急性缺血性中风后的中风严重程度或早期神经病程。
