Brown Devin L, Lisabeth Lynda D, Zupancic Michael J, Concannon Maryann, Martin Cory, Chervin Ronald D
Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
Stroke. 2008 Sep;39(9):2511-4. doi: 10.1161/STROKEAHA.107.513572. Epub 2008 Jul 10.
Sleep apnea is very common after stroke and is associated with poor outcome. Supine sleep is known to exacerbate apneas in the general sleep apnea population. We therefore investigated the pattern of sleep positions in the acute stroke period.
Inpatients with acute ischemic stroke underwent full polysomnography that included continuous monitoring of sleep positions. Sleep apnea severity was measured using the apnea-hypopnea index (AHI). Stroke severity was measured by the NIH Stroke Scale (NIHSS) at the time of study enrollment by certified study personnel. Percent total sleep time spent in the supine position was calculated and compared by stroke severity based on a median split of NIHSS using a Wilcoxon rank-sum test.
Of the 30 patients, the median age was 67. The median AHI was 23 (IQR: 6, 47). Twenty-two patients (73%) had sleep apnea with an AHI >/=5. The vast majority of sleep time among the stroke cases was spent supine, with a median percent sleep time spent supine of 100 (IQR: 62, 100). The majority (63%) of subjects spent no time asleep in any of the nonsupine positions (prone, left, right). Median percent sleep time supine was 100 (IQR: 100, 100) in those with a higher NIHSS and 63 (IQR: 51, 100) in those with a lower NIHSS (P<0.01).
Given the high prevalence of supine sleep identified, research into positional therapy for stroke patients with sleep apnea seems warranted.
睡眠呼吸暂停在中风后非常常见，且与不良预后相关。已知在一般睡眠呼吸暂停人群中，仰卧睡眠会加重呼吸暂停。因此，我们研究了急性中风期的睡眠姿势模式。
急性缺血性中风患者接受了全面的多导睡眠监测，包括对睡眠姿势的持续监测。使用呼吸暂停低通气指数（AHI）来衡量睡眠呼吸暂停的严重程度。在研究入组时，由经过认证的研究人员使用美国国立卫生研究院卒中量表（NIHSS）来衡量中风严重程度。计算仰卧位睡眠总时间百分比，并根据NIHSS的中位数分割将其按中风严重程度进行比较，采用Wilcoxon秩和检验。
30例患者的中位年龄为67岁。中位AHI为23（四分位间距：6，47）。22例患者（73%）患有睡眠呼吸暂停，AHI≥5。中风患者的绝大多数睡眠时间是仰卧位，仰卧位睡眠时间的中位数百分比为100（四分位间距：62，100）。大多数受试者（63%）在任何非仰卧位（俯卧位、左侧卧位、右侧卧位）都没有睡眠时间。NIHSS较高的患者仰卧位睡眠时间的中位数百分比为100（四分位间距：100，100），NIHSS较低的患者为63（四分位间距：51，100）（P<0.01）。
鉴于仰卧睡眠的高发生率，对患有睡眠呼吸暂停的中风患者进行体位治疗的研究似乎是有必要的。
