Medeiros Camila Andrade Mendes, Bruin Veralice Meireles Sales de, Castro-Silva Claudia de, Araújo Sonia Maria Holanda Almeida, Chaves Junior Cauby Maia, Bruin Pedro Felipe Carvalhedo de
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Rev Assoc Med Bras (1992). 2011 Sep-Oct;57(5):559-64. doi: 10.1590/s0104-42302011000500015.
The aim of this study was to evaluate clinical/demographic factors, sleep alterations and one year mortality in acute ischemic stroke.
This was a prospective study of 89 consecutive patients (mean age 64.39 ± 8.51 years) with acute ischemic stroke. High risk of obstructive sleep apnea (OSA) was evaluated by the Berlin questionnaire, daytime somnolence by the Epworth Sleepiness Scale (> 10) and subjective sleep quality by the Pittsburgh Sleep Quality Index (> 5). Clinical and anthropometric data including body mass index, hip-waist ratio, neck circumference (NC) were obtained. Increased NC was defined if > 43 cm in men and > 38 cm in women. Stroke severity was estimated by the Barthel Index and the modified Rankin Scale. The end-point was death after 12 months follow-up.
One-year mortality was 8.9%. Non-survivors were older (p = 0.006) and had larger NC (p = 0.02). Among all cases, large NC was related to high risk of OSA, diabetes and hypertension (Fisher's exact test). Compared to men, women showed relatively larger NC. Overall, family history of stroke (74.2 %), diabetes (33.7%) and hypertension (78.6%) were frequent; obesity (11.2%) was uncommon. Daytime sleepiness (34.8 %), poor sleep quality (65.2%) and risk of OSA (58.42%) were frequently found.
Poor sleep quality, excessive daytime sleepiness and high risk of OSA are frequent in this sample with acute ischemic stroke. One-year mortality was related to older age and large NC. As obesity is uncommon in acute stroke patients, a large NC should be taken as a significant clinical sign related to mortality.
本研究旨在评估急性缺血性卒中的临床/人口统计学因素、睡眠改变及一年死亡率。
这是一项对89例连续急性缺血性卒中患者（平均年龄64.39±8.51岁）的前瞻性研究。通过柏林问卷评估阻塞性睡眠呼吸暂停（OSA）的高风险，通过爱泼华嗜睡量表（>10）评估白天嗜睡情况，通过匹兹堡睡眠质量指数（>5）评估主观睡眠质量。获取包括体重指数、腰臀比、颈围（NC）在内的临床和人体测量数据。男性NC>43 cm且女性NC>38 cm定义为颈围增加。通过巴氏指数和改良Rankin量表评估卒中严重程度。终点为12个月随访后的死亡情况。
一年死亡率为8.9%。非幸存者年龄更大（p = 0.006）且颈围更大（p = 0.02）。在所有病例中，颈围增大与OSA、糖尿病和高血压的高风险相关（Fisher精确检验）。与男性相比，女性颈围相对更大。总体而言，卒中家族史（74.2%）、糖尿病（33.7%）和高血压（78.6%）较为常见；肥胖（11.2%）不常见。经常发现白天嗜睡（34.8%）、睡眠质量差（65.2%）和OSA风险（58.42%）。
在该急性缺血性卒中样本中，睡眠质量差、白天过度嗜睡和OSA高风险较为常见。一年死亡率与年龄较大和颈围增大有关。由于肥胖在急性卒中患者中不常见，颈围增大应被视为与死亡率相关的重要临床体征。
