Cosin Charlotte, Sibon Igor, Poli Mathilde, Allard Michèle, Debruxelles Sabrina, Renou Pauline, Rouanet François, Mayo Willy
Service de Neuroimagerie et Cognition Humaine, INCIA CNRS UMR 5287, EPHE Bordeaux, Bordeaux, France.
Unité Neurovasculaire, CHU Bordeaux, Université Bordeaux2, Bordeaux, France.
Int J Stroke. 2015 Jul;10(5):710-5. doi: 10.1111/ijs.12433. Epub 2014 Dec 25.
Poststroke apathy affects 19-55% of patients following stroke and has a negative impact on functional recovery, general health, and quality of life, as well as being a source of significant burden for caregivers.
A major clinical issue is the delayed diagnosis of poststroke apathy, and so the aim of our study is to evaluate the relationship between early poststroke alterations of circadian rhythms of sleep/wake cycles and the occurrence of poststroke apathy.
Forty-six patients with a recent magnetic resonance imaging confirmed stroke were included. Main exclusion criteria were a mild to severe disability impeding home discharge from the hospital and the presence of apathy or dementia before stroke. Cerebrovascular lesions were evaluated by magnetic resonance imaging. At hospital discharge, an actigraph was used to measure patient's global activity as well as parameters of circadian rhythmicity (relative amplitude, interdaily stability, intradaily variability) and sleep (sleep duration, sleep efficiency, fragmentation index) over seven-days. Apathy was assessed at hospital discharge as well as at three-months using the Apathy Inventory and the Lille Apathy Rating Scale.
Of the 46 patients evaluated, 10 (22%) showed apathy three-months after stroke (median Apathy Inventory = 4·5). Before inclusion, these 10 subjects did not differ significantly from other patients concerning their sleep and, at inclusion, they did not differ concerning apathy, anxiety, depression, or cognitive and functional abilities. However, actigraphy measured at discharged identified significant alterations of sleep (P < 0·005). Future poststroke apathy patients exhibited a decrease in sleep efficiency (actual sleep time expressed as a percentage of time in bed) and an increase in the fragmentation index (degree of fragmentation during the sleep period) at three-months. No association was observed between poststroke apathy and the characteristics of cerebrovascular lesions (stroke location, extent of leucoencephalopathy, number of lacunes and microbleeds).
These results indicate that early poststroke alterations of sleep/wake circadian rhythms--easily evaluated by actigraphy--are associated with a higher risk of poststroke apathy at three-months. In terms of clinical outcomes, our results provide targets for very early identification of patients at risk to develop apathy after stroke and for assessing when to start specific therapy to optimize rehabilitation efficiency.
中风后冷漠影响19% - 55%的中风患者，对功能恢复、总体健康和生活质量产生负面影响，也是照顾者的重大负担来源。
一个主要的临床问题是中风后冷漠的诊断延迟，因此我们研究的目的是评估中风后早期睡眠/觉醒周期昼夜节律改变与中风后冷漠发生之间的关系。
纳入46例近期经磁共振成像确诊为中风的患者。主要排除标准是存在轻度至重度残疾妨碍出院以及中风前存在冷漠或痴呆。通过磁共振成像评估脑血管病变。出院时，使用活动记录仪测量患者七天内的总体活动以及昼夜节律参数（相对振幅、日间稳定性、日内变异性）和睡眠参数（睡眠时间、睡眠效率、碎片化指数）。在出院时以及三个月时使用冷漠量表和里尔冷漠评定量表评估冷漠情况。
在评估的46例患者中，10例（22%）在中风后三个月表现出冷漠（冷漠量表中位数 = 4.5）。在纳入研究前，这10名受试者与其他患者在睡眠方面无显著差异，纳入时在冷漠、焦虑、抑郁或认知及功能能力方面也无差异。然而，出院时通过活动记录仪测量发现睡眠有显著改变（P < 0.005）。未来发生中风后冷漠的患者在三个月时睡眠效率降低（实际睡眠时间占卧床时间的百分比），碎片化指数升高（睡眠期间的碎片化程度）。未观察到中风后冷漠与脑血管病变特征（中风部位、白质脑病范围、腔隙和微出血数量）之间的关联。
这些结果表明，中风后早期睡眠/觉醒昼夜节律的改变 - 通过活动记录仪易于评估 - 与三个月时中风后冷漠的较高风险相关。就临床结果而言，我们的结果为极早期识别中风后有发生冷漠风险的患者以及评估何时开始特定治疗以优化康复效率提供了目标。
